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Are lumbar punctures required for infants with bacteraemic urinary tract infections?
  1. Farhan Ishraq1,
  2. Rami Subhi2,3
  1. 1Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
  2. 2General Paediatrics, Northern Health, Melbourne, Victoria, Australia
  3. 3The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
  1. Correspondence to Dr Rami Subhi, General paediatrics, Northern Health, Melbourne, Victoria, Australia; rami.subhi3{at}nh.org.au

https://doi.org/10.1136/archdischild-2024-327315

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    Scenario

    A 6-week-old girl is admitted with fevers, vomiting and a urine dipstick suggestive of a urinary tract infection (UTI). Inflammatory markers and blood culture are sent to the laboratory, and she is commenced on empirical intravenous antibiotics. The following day, her blood culture flagged positive. It is known that the risk of meningitis in well-appearing infants and children (>4 weeks old) with UTI is low, and a routine lumbar puncture (LP) is not required. But, in the setting of bacteraemia, is an LP now warranted?

    Clinical question

    In infants with bacteraemic UTI, is an LP required to exclude meningitis?

    Search

    A literature search was conducted on OVID MEDLINE up to 26 December 2023 using the following strategy: (paediatric* or paediatric* or child* or infan* or newborn or neonat*) AND (UTI or urinary tract adj4 infec* or urinary adj3 infec* or bacteriuria or urinalysis or cystitis) AND (sepsis or septic* or bacteraemi* or bacteremi* or meningiti* or encephaliti* or meningoencephalitis or lumbar puncture* or spinal puncture* or spinal tap* or cerebrospinal fluid or CSF). Results were restricted to the year 2000 onwards.

    1593 unique articles were identified and screened for title and abstract. Articles were included if the study was in children <18 years old and …

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    Footnotes

    • Collaborators Not applicable.

    • Contributors RS formed the clinical question. FI reviewed the literature. RS conducted the analysis, and RS and FI wrote the manuscript and approved the final version.

    • 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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.