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Infant Escherichia coli urinary tract infection: is it associated with meningitis?
Aisling Rafferty1,2, Richard J Drew3,4,5, Robert Cunney3,5,6
1Department of Pharmacy, Children's Health Ireland at Temple Street, Dublin, Ireland rafferty.aisling@gmail.com.
Insights
The risk of bacterial meningitis (BM) in infants with Escherichia coli urinary tract infection (UTI) is low. Routine lumbar punctures may be reduced, especially in infants under 6 months, with cerebrospinal fluid (CSF) PCR aiding diagnosis.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Neurology
Background:
- Urinary tract infections (UTIs) are common in infants.
- Bacterial meningitis (BM) is a serious infection that can occur alongside UTIs.
- Diagnostic approaches for coexisting BM and UTI require careful consideration.
Purpose of the Study:
- To determine the prevalence of coexisting Escherichia coli (E. coli) BM in infants with E. coli UTI.
- To evaluate the utility of cerebrospinal fluid (CSF) E. coli PCR in diagnosing BM.
- To assess the potential for reducing lumbar punctures (LPs) in this patient population.
Main Methods:
- Retrospective cohort study at a tertiary pediatric hospital.
- Included children aged 8 days to 2 years with E. coli UTI and a CSF sample taken within 48 hours.
- Analyzed CSF for E. coli culture and PCR to detect coexisting BM.
Main Results:
- Out of 1903 patients with E. coli UTI, 314 (16%) had CSF samples analyzed.
- No cases of coexisting E. coli BM were identified.
- Pleocytosis was present in 71 (23%) cases; all CSF E. coli PCR tests were negative.
Conclusions:
- The risk of coexisting E. coli BM in children with E. coli UTI is low.
- Routine LPs may be reduced, particularly in infants up to 6 months old.
- CSF E. coli PCR can help rule out BM in cases of pleocytosis.
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.
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01:26Urine Studies II: Urine Culture and Sensitivity Test