Lumbar puncture and urinary tract infection in infants

You are faced with a febrile, unwell infant (greater than 29 days and younger than 60 days), and you have identified good evidence that they have a urinary tract infection based urinalysis and microscopy of a supra-pubic sample of urine. Should you complete the infection screen with a lumbar puncture (LP) to rule out a co-existing bacterial meningitis? If they are unwell, most clinicians will complete with LP before starting antibiotics. What about well looking infants with fever and evidence of a urinary tract infection, should they have an LP to rule out meningitis? Burstein B et al [JAMA Netw Open 2021;4:e214544. doi:10.1001/jamanetworkopen.2021.4544] have examined the most recent evidence in a systematic review and meta analysis. Most published guidelines for febrile young infants recommend lumbar puncture and cerebrospinal fluid (CSF) testing on the basis of a positive urinalysis result to exclude bacterial meningitis as a cause. The risk is...

from Archives of Disease in Childhood current issue https://ift.tt/3vBXhj2