The Age-Related Risk of Co-Existing Meningitis in Children with Urinary Tract Infection

Abstract

ObjectiveThe primary aim of this study was to determine age-stratified rates of co-existing bacterial meningitis in children with urinary tract infection (UTI). The secondary aims of this study were to determine the causative pathogens of UTI, and the clinical features and outcome of children with co-existing meningitis.MethodsAnalysis of data collected over a nine-year period at a tertiary pediatric hospital in Australia. Study population: children below 16 years of age with culture-confirmed UTI and a paired CSF sample.ResultsA total of 748 episodes in 735 cases were included in the final analysis. The commonest pathogens causing UTI were Escherichia coli (67.4%), Enterococcus faecalis (8.4%), Klebsiella oxytoca (3.5%) and Klebsiella pneumoniae (3.5%). Only two (1.2%; 95% CI: 0.15–4.36%) of 163 neonates (between 0 and 28 days of age) with UTI had co-existing meningitis. Both presented with pyrexia, irritability and lethargy, and recovered uneventfully with antibiotic treatment. There were no cases of co-existing meningitis among 499 infants (between 29 days and 12 months of age) with UTI (95% CI: 0.00–0.74%), or any of the 86 children aged 12 months or over (95% CI: 0.00–4.20%).ConclusionsThese findings indicate that clinicians should have a low threshold to perform a lumbar puncture in neonates with UTI, as the risk of co-existing meningitis is not insignificant in this age group. In contrast, beyond the neonatal period, the risk is small and a more selective approach is warranted.

Epidemiology of Bacteremia in Previously Healthy Febrile Infants: A Follow-up Study

“…27 More recent literature suggests that older infants (30-90 days of life) with UTI have a low rate of concurrent meningitis. [28][29][30] It has been suggested that in well-appearing infants in this age group considered to be at low risk on presentation, lumbar puncture to assess for concurrent meningitis may not be necessary. 31,32 However, because our study only examines children with bacteremia, which may indicate a higher level of illness compared with the standard child presenting with UTI, it is diffi cult to draw fi rm conclusions about the role of lumbar puncture in infants with both bacteremia and UTI.…”

Isolation, Molecular Identification and Antibiotic Resistance of Enterococcus faecalis from Diseased Tilapia

“…Nonetheless, Enterococcus sp. in contaminated food fishes can lead to lifethreatening illness in human such as endocarditis (Dahl and Bruun, 2013), bacteremia (Stuart et al, 2006), urinary tract infection and meningitis (Tebruegge et al, 2011) and its resistance to antibiotics is emerging as a major problem in treating these infections (Koch et al, 2004). In addition, the ubiquity of Enterococcus sp in food has been reported to be mainly a result of their resistance to unfavorable environmental conditions during production technology with food fish storage conditions and their adaptability (Sarra et al, 2013).…”

Targeting Enterococcus faecalis Biofilms with Phage Therapy

“…Nonetheless, it can cause life-threatening infections such as endocarditis (1), bacteremia (2), urinary tract infection, and meningitis (3), and it appears especially in hospitals where resistance to antibiotics is developed (4). In addition, E. faecalis is frequently recovered from secondary persistent infections associated with root canal treatment failures (5,6) that can result in invasion to the tissues surrounding the tip of the tooth-root (periradicular tissue) with subsequent development of abscesses and diffused infections (cellulitis) (7).…”