Does a Positive Urinalysis on a Sepsis Evaluation in a Young Infant Still Require That a Lumbar Puncture Also be Performed? :

A febrile infant under two months of age (and if two months is not your cut-off, then at least under one month of age) usually means a sepsis evaluation to detect a serious bacterial infection is warranted. Usually cultures of blood, urine and cerebrospinal fluid (CSF) need to be obtained, but what if the urinalysis is suggestive of a urinary tract infection as the cause for the baby’s fever?  If the infant is not lethargic, has no bulging fontanelle nor an abnormal or focal neurologic exam, does the lumbar puncture (LP) really need to be done?  Wang et al. (10.1542/peds.2018-3979) decided to investigate this question in a study being early released this week, using data from a retrospective cohort enrolled in the Reducing Excessive Variability in Infant Sepsis Evaluation (REVISE) Study. The authors looked at over 20,000 well-appearing infants with fever ages 7 to 60 days of age at 124 different hospitals between 2015-17 to determine what factors were associated with the need for CSF testing.  The authors found 3,572 infants with a positive urinalysis, of whom 2,511 (70.3%) had LPs performed, with variations noted by age of infant and site of sepsis evaluation.  Of note, 505 infants who were treated for UTI did not receive an LP and none developed meningitis either acutely or within 7 days of being discharged.  Does this convince you to hold on the LP if the baby looks good and has evidence of a UTI?  Check out the detailed findings in this study and see if it REVISEs your approach to febrile infants with a UTI.