PECARN: Low Risk of Bacterial Meningitis in Young Febrile Infants

Given the ongoing surge crisis, emergency providers may be seeing an increase in infants with fevers. When infants less than 60 days of age present with evidence of urinary tract infection (UTI), there is often a concern for possible bacteremia or bacterial meningitis. However, given the invasive nature and cost of blood cultures and lumbar punctures, clinicians may question if this risk is real or hypothetical.

A study published last month in Pediatrics sought to uncover the prevalence of bacteremia and bacterial meningitis in a large group of babies younger than 60 days.

The study was led by Prashant Mahajan, MD, MPH, MBA, and a team of researchers and was sponsored by the Great Lakes Area Children’s Emergency Research (GLACiER) node of the Pediatric Emergency Care Applied Research Network (PECARN), EMSC’s clinical research arm.

Study methods and findings

In this observational study, 7,407 febrile infants were enrolled from 26 emergency departments (EDs) across PECARN sites. Enrolled infants had temperatures ≥ 38° C in the ED from a referring facility or by history. Infants were excluded if they had history of prematurity (fewer than 37 weeks’ gestation), significant comorbid conditions, antibiotic use in the preceding 48 hours, and those with critical illnesses requiring endotracheal intubation or vasoactive medication.

Approximately 15% of the infants had urinalysis (UA) results consistent with UTI. The risk of bacteremia was higher in those with positive vs. negative UA results (5.8% vs. 1.1%). The risk of meningitis in those younger than or equal to 28 days with positive UA were identical to those with negative UA (1%). There were no cases of bacterial meningitis in babies 29 to 60 days of age with positive UA. However, nine infants with negative UA did have bacterial meningitis (0.2%). Finally, there were no cases of bacteremia or bacterial meningitis in infants ≤ 60 days who had the PECARN low-risk blood threshold (absolute neutrophil count < 4 × 103 cells/mm3 and procalcitonin <0.5 ng/mL).

As a result, the authors conclude that the risk of bacteremia and bacterial meningitis is low in well-appearing, low-risk infants 60 days old or younger with positive UA results and low-risk PECARN blood thresholds (0 cases in this study).

“These findings can guide lumbar puncture use and other clinical decision making,” says Michael Patrick, MD, a dissemination expert for GLACiER and PECARN.

For more information on care of febrile infants, view the video abstract from the Pediatrics article or check out this recent EM Pulse podcast. For more information about PECARN, visit pecarn.org.