InfantEscherichia coliurinary tract infection: is it associated with meningitis?

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Objectives 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 ofEscherichia coliurinary tract infection (UTI), with the addition of CSFE. coliPCR analysis. Design Single-centre, retrospective cohort study. Setting Tertiary paediatric hospital. Participants Children aged 8 days to 2 years, with a pure growth ofE. colifrom urine and a CSF sample taken within 48 hours of a positive urine culture between 1 January 2014 and 30 April 2019. Main outcome measure Prevalence of coexistingE. coliBM with UTI, defined as a pure growthE. colifrom urine and a CSF culture with pure growthE. coliand/or positiveE. coliPCR. Results 1903 patients had anE. coliUTI, of which 314 (16%) had a CSF sample taken within 48 hours. No cases of coexistingE. coliBM were identified. There were 71 (23%) cases of pleocytosis, 57 (80%) of these had PCR analysis, all of which wereE. coliPCR not detected. Patients aged 1–6 months accounted for 72% of all lumbar punctures (LPs). Conclusion The risk ofE. coliUTI and coexistingE. coliBM is low. There is potential to reduce the number of routine LPs in infants with a diagnosis ofE. coliUTI with the greatest impact in children up to 6 months of age. CSFE. coliPCR can help further reduce post-test probability of BM in the setting of pleocytosis.

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