HOW COMMON IS CO-EXISTING MENINGITIS IN INFANTS WITH URINARY TRACT INFECTION? SCENARIO

You are asked to review a febrile 2-month-old infant who presented to the accident and emergency department. The urine analysis carried out before your arrival is suggestive of urinary tract infection (UTI) (urine dipstick: positive for nitrites and white blood cells (WBCs); micros-copy: 220 WBCs per high powered fi eld). On examination the infant appears well and has no signs suggestive of menin-gitis. However, you recall a senior col-league stating that young infants with UTI should always have a full septic workup to rule out co-existing bacterial meningitis. You wonder if there is any evidence to support routinely perform-ing a lumbar puncture in this setting? STRUCTURED CLINICAL QUESTION In an infant with UTI [patient], is a lumbar puncture [test] indicated to rule out co-existing bacterial meningitis [outcome]? SEARCH STRATEGY AND OUTCOME Search of the Cochrane Library data-base using the terms ‘Urinary Tract Infection ’ and ‘pyelonephritis ’ retrieved 18 Cochrane reviews, none of which were relevant. Medline was searched using the PubMed interface (1950—to date/no limits set): (1) a keyword search using (Urinary Tract Infection OR pyelonephritis OR cystitis) AND (meningitis OR meningoencephalitis OR lumbar puncture) AND (neonat* OR infant) retrieved 507 publications, of which 11 were relevant,1–11 and (2) a search using the MeSH terms (‘Infant