title: Sterile cerebrospinal fluid pleocytosis in young febrile infants with urinary tract infections.
abstract: OBJECTIVE
  To determine the prevalence of and to identify risk factors for sterile cerebrospinal fluid (CSF) pleocytosis in a large sample of febrile young infants with urinary tract infections (UTIs) and to describe the clinical courses of those patients.
  
  
  METHODS
  Secondary analysis of a multicenter retrospective review.
  
  
  METHODS
  Emergency departments of 20 North American hospitals. Patients Infants aged 29 to 60 days with temperatures of 38.0°C or higher and culture-proven UTIs who underwent a nontraumatic lumbar puncture from January 1, 1995, through May 31, 2006.
  
  
  METHODS
  Febrile UTI.
  
  
  METHODS
  Presence of sterile CSF pleocytosis defined as CSF white blood cell count of 10/μL or higher in the absence of bacterial meningitis and clinical course and treatment (ie, presence of adverse events, time to defervescence, duration of parenteral antibiotic treatment, and length of hospitalization).
  
  
  RESULTS
  A total of 214 of 1190 infants had sterile CSF pleocytosis (18.0%; 95% confidence interval, 15.9%-20.3%). Only the peripheral white blood cell count was independently associated with sterile CSF pleocytosis, and patients with a peripheral white blood cell count of 15/μL or higher had twice the odds of having sterile CSF pleocytosis (odds ratio, 1.97; 95% confidence interval, 1.32-2.94; P = .001). In the subset of patients at very low risk for adverse events (ie, not clinically ill in the emergency department and without a high-risk medical history), patients with and without sterile CSF pleocytosis had similar clinical courses; however, patients with CSF pleocytosis had longer parenteral antibiotics courses (median length, 4 days [interquartile range, 3-6 days] vs 3 days [interquartile range, 3-5 days]) (P = .04).
  
  
  CONCLUSIONS
  Sterile CSF pleocytosis occurs in 18% of young infants with UTIs. Patients with CSF pleocytosis at very low risk for adverse events may not require longer treatment with antibiotics.
authors: Division of Pediatric Emergency Medicine, Washington University in St Louis School of Medicine, 660 S Euclid Ave, PO Box 8116, St Louis, MO 63110, USA. schnadower_d@kids.wustl.edu
authors: David
authors: D
authors: Schnadower
authors: Nathan
authors: N
authors: Kuppermann
authors: Charles G
authors: CG
authors: Macias
authors: Stephen B
authors: SB
authors: Freedman
authors: Marc N
authors: MN
authors: Baskin
authors: Paul
authors: P
authors: Ishimine
authors: Camille
authors: C
authors: Scribner
authors: Pamela
authors: P
authors: Okada
authors: Heather
authors: H
authors: Beach
authors: Blake
authors: B
authors: Bulloch
authors: Dewesh
authors: D
authors: Agrawal
authors: Mary
authors: M
authors: Saunders
authors: Donna M
authors: DM
authors: Sutherland
authors: Mercedes M
authors: MM
authors: Blackstone
authors: Amit
authors: A
authors: Sarnaik
authors: Julie
authors: J
authors: McManemy
authors: Alison
authors: A
authors: Brent
authors: Jonathan
authors: J
authors: Bennett
authors: Jennifer M
authors: JM
authors: Plymale
authors: Patrick
authors: P
authors: Solari
authors: Deborah J
authors: DJ
authors: Mann
authors: Peter S
authors: PS
authors: Dayan
mesh_terms: D016009:Chi-Square Distribution; D005260:Female; D005334:Fever / Q000134:cerebrospinal fluid*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007964:Leukocytosis / Q000134:cerebrospinal fluid* / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013129:Spinal Puncture; D018709:Statistics, Nonparametric; D014552:Urinary Tract Infections / Q000134:cerebrospinal fluid*