title: The age-related risk of co-existing meningitis in children with urinary tract infection.
abstract: OBJECTIVE
  The 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.
  
  
  METHODS
  Analysis of data collected over a nine-year period at a tertiary pediatric hospital in Australia.
  
  
  METHODS
  children below 16 years of age with culture-confirmed UTI and a paired CSF sample.
  
  
  RESULTS
  A 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%).
  
  
  CONCLUSIONS
  These 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.
authors.affiliation: Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia. marc.tebruegge@rch.org.au
authors.forename: Marc
authors.initials: M
authors.lastname: Tebruegge
authors.forename: Anastasia
authors.initials: A
authors.lastname: Pantazidou
authors.forename: Vanessa
authors.initials: V
authors.lastname: Clifford
authors.forename: Gena
authors.initials: G
authors.lastname: Gonis
authors.forename: Nicole
authors.initials: N
authors.lastname: Ritz
authors.forename: Tom
authors.initials: T
authors.lastname: Connell
authors.forename: Nigel
authors.initials: N
authors.lastname: Curtis
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D013293:Enterococcus faecalis / Q000472:pathogenicity; D004926:Escherichia coli / Q000472:pathogenicity; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D041121:Klebsiella oxytoca / Q000472:pathogenicity; D007711:Klebsiella pneumoniae / Q000472:pathogenicity; D008297:Male; D008581:Meningitis / Q000453:epidemiology* / Q000382:microbiology; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology
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