Background. Aseptic meningitis associated with urinary tract infection (UTI) in young infants has not been described in detail in the literature. We performed a retrospective study to determine the incidence and clinical features of aseptic meningitis accompanying UTI.
Methods. We retrospectively reviewed the medical records of all infants younger than 6 months of age hospitalized with a UTI at Miller Children’s Hospital from March 1995 through March 2000. UTI was defined as a urine culture growing ≥10 000 colony-forming units/ml of a single organism from a catheterized specimen or ≥100 000 colony-forming units/ml of a single organism from a bagged urine specimen. Meningitis was defined as a positive cerebrospinal fluid culture or cerebrospinal fluid with >35 white blood cells/mm3 in infants ≤30 days of age or with >10 white blood cells/mm3 in infants >30 days of age.
Results. Of 386 infants with UTI, a lumbar puncture was performed in 260, and 31 (11.9%) had aseptic meningitis. One infant had bacterial meningitis. None of the 26 infants with UTI and bacteremia had aseptic meningitis. Two infants with meningitis had confirmed enteroviral infections, but aseptic meningitis did not occur more frequently in any particular month or during times of peak enteroviral activity.
Conclusions. A cerebrospinal fluid pleocytosis is relatively common in hospitalized infants <6 months of age who have a UTI and usually does not reflect bacterial meningitis. Knowledge of this may prevent unnecessary courses of antibiotics for presumed bacterial meningitis and lead to evaluation for other possible causes of aseptic meningitis including viral or congenital infections.
From Pediatric Infectious Diseases, Miller Children’s Hospital, Long Beach, CA (FCAS, MMC, JML); and University of California, Irvine, CA (FCAS, MMC, MAH, JML).
Accepted for publication Aug. 28, 2003.
Address for reprints: Felice C. Adler-Shohet, M.D., Miller Children’s Hospital, 2801 Atlantic Ave., P.O. Box 1428, Long Beach, CA 90801-1428. Fax 562-997-9634; firstname.lastname@example.org.
Presented in part at the 39th annual meeting of the Infectious Diseases Society of America. 17