Infant <i>Escherichia coli</i> urinary tract infection: is it associated with meningitis?

Abstract

Determine the prevalence of coexisting bacterial meningitis (BM) and sterile cerebrospinal fluid (CSF) with raised white cell count relative to age ('pleocytosis') in the presence of <i>Escherichia coli</i> urinary tract infection (UTI), with the addition of CSF <i>E. coli</i> PCR analysis. Single-centre, retrospective cohort study. Tertiary paediatric hospital. Children aged 8 days to 2 years, with a pure growth of <i>E. coli</i> from urine and a CSF sample taken within 48 hours of a positive urine culture between 1 January 2014 and 30 April 2019. Prevalence of coexisting <i>E. coli</i> BM with UTI, defined as a pure growth <i>E. coli</i> from urine and a CSF culture with pure growth <i>E. coli</i> and/or positive <i>E. coli</i> PCR. 1903 patients had an <i>E. coli</i> UTI, of which 314 (16%) had a CSF sample taken within 48 hours. No cases of coexisting <i>E. coli</i> BM were identified. There were 71 (23%) cases of pleocytosis, 57 (80%) of these had PCR analysis, all of which were <i>E. coli</i> PCR not detected. Patients aged 1-6 months accounted for 72% of all lumbar punctures (LPs). The risk of <i>E. coli</i> UTI and coexisting <i>E. coli</i> BM is low. There is potential to reduce the number of routine LPs in infants with a diagnosis of <i>E. coli</i> UTI with the greatest impact in children up to 6 months of age. CSF <i>E. coli</i> PCR can help further reduce post-test probability of BM in the setting of pleocytosis.