Sterile cerebrospinal fluid pleocytosis in young febrile infants with urinary tract infections

David Schnadower, Nathan Kuppermann, Charles G. Macias, Stephen B. Freedman, Marc N. Baskin, Paul Ishimine, Camille Scribner, Pamela Okada, Heather Beach, Blake Bulloch, Dewesh Agrawal, Mary Saunders, Donna M. Sutherland, Mercedes M. Blackstone, Amit Sarnaik, Julie McManemy, Alison Brent, Jonathan Bennett, Jennifer M. Plymale, Patrick SolariDeborah J. Mann, Peter S. Dayan

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objectives: 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. Design: Secondary analysis of a multicenter retrospective review. Setting: 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. Main Exposure: Febrile UTI. Outcome Measures: 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: Atotal 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). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)635-641
Number of pages7
JournalArchives of Pediatrics and Adolescent Medicine
Volume165
Issue number7
DOIs
StatePublished - Jul 2011

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Leukocytosis
Urinary Tract Infections
Cerebrospinal Fluid
Fever
Leukocyte Count
Anti-Bacterial Agents
Hospital Emergency Service
Confidence Intervals
Bacterial Meningitides
Spinal Puncture
Hospitalization
Therapeutics
Odds Ratio
Outcome Assessment (Health Care)
Temperature

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Sterile cerebrospinal fluid pleocytosis in young febrile infants with urinary tract infections. / Schnadower, David; Kuppermann, Nathan; Macias, Charles G.; Freedman, Stephen B.; Baskin, Marc N.; Ishimine, Paul; Scribner, Camille; Okada, Pamela; Beach, Heather; Bulloch, Blake; Agrawal, Dewesh; Saunders, Mary; Sutherland, Donna M.; Blackstone, Mercedes M.; Sarnaik, Amit; McManemy, Julie; Brent, Alison; Bennett, Jonathan; Plymale, Jennifer M.; Solari, Patrick; Mann, Deborah J.; Dayan, Peter S.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 165, No. 7, 07.2011, p. 635-641.

Research output: Contribution to journalArticle

Schnadower, D, Kuppermann, N, Macias, CG, Freedman, SB, Baskin, MN, Ishimine, P, Scribner, C, Okada, P, Beach, H, Bulloch, B, Agrawal, D, Saunders, M, Sutherland, DM, Blackstone, MM, Sarnaik, A, McManemy, J, Brent, A, Bennett, J, Plymale, JM, Solari, P, Mann, DJ & Dayan, PS 2011, 'Sterile cerebrospinal fluid pleocytosis in young febrile infants with urinary tract infections', Archives of Pediatrics and Adolescent Medicine, vol. 165, no. 7, pp. 635-641. https://doi.org/10.1001/archpediatrics.2011.104
Schnadower, David ; Kuppermann, Nathan ; Macias, Charles G. ; Freedman, Stephen B. ; Baskin, Marc N. ; Ishimine, Paul ; Scribner, Camille ; Okada, Pamela ; Beach, Heather ; Bulloch, Blake ; Agrawal, Dewesh ; Saunders, Mary ; Sutherland, Donna M. ; Blackstone, Mercedes M. ; Sarnaik, Amit ; McManemy, Julie ; Brent, Alison ; Bennett, Jonathan ; Plymale, Jennifer M. ; Solari, Patrick ; Mann, Deborah J. ; Dayan, Peter S. / Sterile cerebrospinal fluid pleocytosis in young febrile infants with urinary tract infections. In: Archives of Pediatrics and Adolescent Medicine. 2011 ; Vol. 165, No. 7. pp. 635-641.
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abstract = "Objectives: 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. Design: Secondary analysis of a multicenter retrospective review. Setting: 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. Main Exposure: Febrile UTI. Outcome Measures: 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: Atotal 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). Conclusion: 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.",
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AU - Schnadower, David

AU - Kuppermann, Nathan

AU - Macias, Charles G.

AU - Freedman, Stephen B.

AU - Baskin, Marc N.

AU - Ishimine, Paul

AU - Scribner, Camille

AU - Okada, Pamela

AU - Beach, Heather

AU - Bulloch, Blake

AU - Agrawal, Dewesh

AU - Saunders, Mary

AU - Sutherland, Donna M.

AU - Blackstone, Mercedes M.

AU - Sarnaik, Amit

AU - McManemy, Julie

AU - Brent, Alison

AU - Bennett, Jonathan

AU - Plymale, Jennifer M.

AU - Solari, Patrick

AU - Mann, Deborah J.

AU - Dayan, Peter S.

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N2 - Objectives: 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. Design: Secondary analysis of a multicenter retrospective review. Setting: 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. Main Exposure: Febrile UTI. Outcome Measures: 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: Atotal 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). Conclusion: 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.

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