Article Text

Download PDFPDF
Infant Escherichia coli urinary tract infection: is it associated with meningitis?
  1. Aisling Rafferty1,2,
  2. Richard J Drew3,4,5,
  3. Robert Cunney3,5,6,
  4. Désirée Bennett3,
  5. John Francis Marriott2
  1. 1Department of Pharmacy, Children’s Health Ireland at Temple Street, Dublin, Ireland
  2. 2School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
  3. 3Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland
  4. 4Clinical Innovation Unit, Rotunda Hospital, Dublin, Ireland
  5. 5Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
  6. 6Department of Microbiology, Children’s Health Ireland at Temple Street, Dublin, Ireland
  1. Correspondence to Aisling Rafferty, University of Birmingham, Birmingham, UK; rafferty.aisling{at}gmail.com

Abstract

Objectives Determine the prevalence of coexisting bacterial meningitis (BM) and sterile cerebrospinal fluid (CSF) with raised white cell count relative to age (‘pleocytosis’) in the presence of Escherichia coli urinary tract infection (UTI), with the addition of CSF E. coli PCR analysis.

Design Single-centre, retrospective cohort study.

Setting Tertiary paediatric hospital.

Participants Children aged 8 days to 2 years, with a pure growth of E. coli from urine and a CSF sample taken within 48 hours of a positive urine culture between 1 January 2014 and 30 April 2019.

Main outcome measure Prevalence of coexisting E. coli BM with UTI, defined as a pure growth E. coli from urine and a CSF culture with pure growth E. coli and/or positive E. coli PCR.

Results 1903 patients had an E. coli UTI, of which 314 (16%) had a CSF sample taken within 48 hours. No cases of coexisting E. coli BM were identified. There were 71 (23%) cases of pleocytosis, 57 (80%) of these had PCR analysis, all of which were E. coli PCR not detected. Patients aged 1–6 months accounted for 72% of all lumbar punctures (LPs).

Conclusion The risk of E. coli UTI and coexisting E. coli BM is low. There is potential to reduce the number of routine LPs in infants with a diagnosis of E. coli UTI with the greatest impact in children up to 6 months of age. CSF E. coli PCR can help further reduce post-test probability of BM in the setting of pleocytosis.

  • data collection
  • microbiology
  • neonatology

Data availability statement

Data are available on reasonable request. Data are available on reasonable request from rafferty.aisling@gmail.com.

Statistics from Altmetric.com

Data availability statement

Data are available on reasonable request. Data are available on reasonable request from rafferty.aisling@gmail.com.

View Full Text

Footnotes

  • Twitter @AisRafferty

  • Contributors AR designed the study, preformed data verification, analysis, interpreted the data and drafted the manuscript. RC, JFM and RJD designed the study and interpreted the data. DB extracted data and preformed data analysis, verification and interpretation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.