The age-related risk of co-existing meningitis in children with urinary tract infection
The age-related risk of co-existing meningitis in children with urinary tract infection
Objective: The primary aim of this study was to determine age-stratified rates of co-existing bacterial meningitis in children with urinary tract infection (UTI). The secondary aims of this study were to determine the causative pathogens of UTI, and the clinical features and outcome of children with co-existing meningitis.
Methods: Analysis of data collected over a nine-year period at a tertiary pediatric hospital in Australia. Study population: children below 16 years of age with culture-confirmed UTI and a paired CSF sample.
Results: A total of 748 episodes in 735 cases were included in the final analysis. The commonest pathogens causing UTI were Escherichia coli (67.4%), Enterococcus faecalis (8.4%), Klebsiella oxytoca (3.5%) and Klebsiella pneumoniae (3.5%). Only two (1.2%; 95% CI: 0.15–4.36%) of 163 neonates (between 0 and 28 days of age) with UTI had co-existing meningitis. Both presented with pyrexia, irritability and lethargy, and recovered uneventfully with antibiotic treatment. There were no cases of co-existing meningitis among 499 infants (between 29 days and 12 months of age) with UTI (95% CI: 0.00–0.74%), or any of the 86 children aged 12 months or over (95% CI: 0.00–4.20%).
Conclusions: These findings indicate that clinicians should have a low threshold to perform a lumbar puncture in neonates with UTI, as the risk of co-existing meningitis is not insignificant in this age group. In contrast, beyond the neonatal period, the risk is small and a more selective approach is warranted.
infectious diseases, microbiology, neurological disorders, pediatrics and child health, public health and epidemiology
e26576
Tebruegge, Marc
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Pantazidou, Anastasia
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Clifford, Vanessa
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Gonis, Gena
90467b02-e323-449d-bbd2-822c1fa7b848
Ritz, Nicole
ce6604a1-f373-4d76-838a-1ae75f35b20b
Connell, Tom
7c1afb37-45bd-44a3-a274-20839e68f2c3
Curtis, Nigel
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9 November 2011
Tebruegge, Marc
2c3dff22-0b5f-48a7-bb36-ce323705f74a
Pantazidou, Anastasia
7264d9c8-59ea-49c5-a933-6b2e5fbef7d4
Clifford, Vanessa
bf6063da-16e9-4b72-b4e7-ba2582ac3eb5
Gonis, Gena
90467b02-e323-449d-bbd2-822c1fa7b848
Ritz, Nicole
ce6604a1-f373-4d76-838a-1ae75f35b20b
Connell, Tom
7c1afb37-45bd-44a3-a274-20839e68f2c3
Curtis, Nigel
60e08f70-7ce9-42b3-8074-d5df55131b12
Tebruegge, Marc, Pantazidou, Anastasia, Clifford, Vanessa, Gonis, Gena, Ritz, Nicole, Connell, Tom and Curtis, Nigel
(2011)
The age-related risk of co-existing meningitis in children with urinary tract infection.
PLoS ONE, 6 (11), .
(doi:10.1371/journal.pone.0026576).
(PMID:22096488)
Abstract
Objective: The primary aim of this study was to determine age-stratified rates of co-existing bacterial meningitis in children with urinary tract infection (UTI). The secondary aims of this study were to determine the causative pathogens of UTI, and the clinical features and outcome of children with co-existing meningitis.
Methods: Analysis of data collected over a nine-year period at a tertiary pediatric hospital in Australia. Study population: children below 16 years of age with culture-confirmed UTI and a paired CSF sample.
Results: A total of 748 episodes in 735 cases were included in the final analysis. The commonest pathogens causing UTI were Escherichia coli (67.4%), Enterococcus faecalis (8.4%), Klebsiella oxytoca (3.5%) and Klebsiella pneumoniae (3.5%). Only two (1.2%; 95% CI: 0.15–4.36%) of 163 neonates (between 0 and 28 days of age) with UTI had co-existing meningitis. Both presented with pyrexia, irritability and lethargy, and recovered uneventfully with antibiotic treatment. There were no cases of co-existing meningitis among 499 infants (between 29 days and 12 months of age) with UTI (95% CI: 0.00–0.74%), or any of the 86 children aged 12 months or over (95% CI: 0.00–4.20%).
Conclusions: These findings indicate that clinicians should have a low threshold to perform a lumbar puncture in neonates with UTI, as the risk of co-existing meningitis is not insignificant in this age group. In contrast, beyond the neonatal period, the risk is small and a more selective approach is warranted.
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Published date: 9 November 2011
Keywords:
infectious diseases, microbiology, neurological disorders, pediatrics and child health, public health and epidemiology
Organisations:
Faculty of Medicine
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Local EPrints ID: 337532
URI: http://eprints.soton.ac.uk/id/eprint/337532
ISSN: 1932-6203
PURE UUID: e4c7e7a4-bfab-4304-b50a-e7d9e07bd5dc
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Date deposited: 26 Apr 2012 15:34
Last modified: 14 Mar 2024 10:54
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Author:
Marc Tebruegge
Author:
Anastasia Pantazidou
Author:
Vanessa Clifford
Author:
Gena Gonis
Author:
Nicole Ritz
Author:
Tom Connell
Author:
Nigel Curtis
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