It is unknown whether febrile infants 29 to 60 days old with positive urinalysis results require routine lumbar punctures for evaluation of bacterial meningitis. OBJECTIVE To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. METHODS Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results. RESULTS Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference in the prevalence of bacterial meningitis in infants ≤28 days of age with positive versus negative UA results (∼1% in both groups). However, among 697 infants aged 29 to 60 days with positive UA results, there were no cases of bacterial meningitis in comparison to 9 of 4153 with negative UA results (0.2%, difference -0.2% [-0.4% to -0.1%]). In addition, there were no cases of bacteremia and/or bacterial meningitis in the 148 infants ≤60 days of age with positive UA results who had the Pediatric Emergency Care Applied Research Network low-risk blood thresholds of absolute neutrophil count <4 × 103 cells/mm3 and procalcitonin <0.5 ng/mL. CONCLUSIONS Among noncritical febrile infants ≤60 days of age with positive UA results, there were no cases of bacterial meningitis in those aged 29 to 60 days and no cases of bacteremia and/or bacterial meningitis in any low-risk infants based on low-risk blood thresholds in both months of life. These findings can guide lumbar puncture use and other clinical decision making.

中文翻译：

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尿液分析结果呈阳性的发热婴儿的严重细菌感染。

目前尚不清楚尿检结果呈阳性的 29 至 60 天发热婴儿是否需要常规腰椎穿刺来评估细菌性脑膜炎。目的 确定尿液分析（UA）结果呈阳性的 ≤60 日龄发热婴儿中菌血症和/或细菌性脑膜炎的患病率。方法 对 2011 年至 2019 年在儿科急救应用研究网络急诊科进行的一项针对 ≤60 天的非危重发热婴儿的前瞻性观察性研究进行了二次分析。参与者的体温≥38°C，并通过血培养进行评估，并有可用于分析的UA。我们报告了 UA 结果呈阳性和未呈阳性的患者中菌血症和细菌性脑膜炎的患病率。结果 在 7180 名婴儿中，1090 名（15.2%）的 UA 结果呈阳性。UA 结果呈阳性的患者与阴性的患者相比，菌血症的风险较高（63/1090 [5.8%] vs 69/6090 [1.1%]，差异 4.7% [3.3% 至 6.1%]）。UA 结果呈阳性与阴性的 ≤28 天婴儿的细菌性脑膜炎患病率没有差异（两组均为 1%）。然而，在 697 名 29 至 60 天 UA 结果呈阳性的婴儿中，没有出现细菌性脑膜炎病例，而 4153 名 UA 结果呈阴性的婴儿中有 9 名没有出现细菌性脑膜炎病例（0.2%，差异 -0.2% [-0.4% 至 -0.1%]） 。此外，148名UA结果呈阳性且年龄≤60日且具有儿科急救应用研究网络低危血液阈值中性粒细胞绝对计数<4×103个细胞的婴儿中，没有出现菌血症和/或细菌性脑膜炎病例/mm3 和降钙素原 <0.5 ng/mL。结论 UA结果阳性的≤60日龄非危重发热婴儿中，29~60日龄婴儿中未出现细菌性脑膜炎病例，基于低危的低危婴儿中未出现菌血症和/或细菌性脑膜炎病例。生命中两个月的血液阈值。这些发现可以指导腰椎穿刺的使用和其他临床决策。