You’re seeing a febrile well-appearing 29-60 day old with clear lab evidence of UTI and benign CBC. Do you do an LP? Do you admit and do you give parenteral antibiotics? What about for a 61-90 day old?
You’re seeing a febrile well-appearing 29-60 day old with clear lab evidence of UTI and benign CBC. Do you do an LP? Do you admit and do you give parenteral antibiotics? What about for a 61-90 day old?
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June 9, 2016 at 5:22 am
Pediatric EM Morsels has a great discussion on this topic at http://pedemmorsels.com/concurrent-meningitis-in-infant-with-uti/
For the 29-60 day old, literature (below) shows the risk of bacterial meningitis to be low but not zero (about 0.3%). The AAP guidelines support outpatient therapy with oral antibiotics for > 2 months old. Experts often recommend avoiding parenteral antibiotics (eg ceftriaxone) without LP in 60 day olds, can consider no LP and outpatient management with oral antibiotics. Of course, it goes without saying that this is only for well appearing infants.
Literature:
– Greenhow TL, et al. Pediatr Infect Dis J 2014;33(6):595-599
All fullterm 1 week to 3mo old with cultures sent (Kaiser)
4599 urine cultures: 823 UTI positive (17%). 2 E coli meningitis & UTI (with negative blood cultures in both) – one < 28 days old, one 29-60 days old; 2/823 = 0.24%
– Tebruegge M, et al. PLoS One 2011;6(11):e26576
< 16yo with UTI and CSF done; 2/735 = 0.27%
735 cases: 2 of 163 neonates (0-28 days) = 1.2% had meningitis. None of 499 aged 29 days-12mo, none of 86 aged 12 months or older
– Schnadower D, et al. Arch Pediatr Adolesc Med 2011;165(7):635-641
Schnadower D, et al. Pediatrics 2010;126(6):1074-1083
Febrile 29-60 day olds with UTI: 1895 patients with UTI, 6.5% bacteremia
214/1190 with non-traumatic LP had sterile CSF pleocytosis (18%)
5 of total 1609 (0.31%) with LP done had bacterial meningitis