Can CSF testing be omitted in febrile infants with positive UTI?

Takeaway

• In otherwise well-appearing infants with febrile urinary tract infection (UTI), omitting cerebrospinal fluid (CSF) testing to rule out meningitis yielded no cases of delayed bacterial meningitis at 7 days postdischarge in this study.

Why this matters

• These authors say that meningitis testing of infants aged 31-60 days with fever and positive urinalysis “may not be necessary".
• Sparing infants a spinal tap that adds little would be desirable.

Key results

• 29.7% of the cohort did not have CSF testing and were treated for UTI.
• Among these, none had delayed meningitis at 7 days (95% CI, 0%-0.6%).
• CSF testing varied across sites and was more likely for infants aged 7-30 days.
• Infants who had CSF testing more often (aORs; 95% CI):
  • Were younger: 4.6 (3.8-5.5) days;
  • Had abnormal inflammatory markers: 2.2 (1.8-2.5); and
  • Were at higher volume centers (>300 infants with fever each year): 1.8 (1.2-2.6).

Study design

• Retrospective cohort study including 20,570 infants, aged 7-60 days presenting with fever but well-appearing at 124 hospitals, 2015-2017.
• Funding: None.

Limitations

• No details on symptoms, laboratory studies, treatment used.
• Retrospective design.