Sterile Cerebrospinal Fluid Pleocytosis in Young Febrile Infants With Urinary Tract Infections

被引：24

作者：

Schnadower, David ^{[1
]}

Kuppermann, Nathan ^{[16
,17
]}

Macias, Charles G. ^{[2
]}

Freedman, Stephen B. ^{[18
,19
,20
]}

Baskin, Marc N. ^{[21
]}

Ishimine, Paul ^{[22
]}

Scribner, Camille ^{[3
]}

Okada, Pamela ^{[4
]}

Beach, Heather ^{[5
]}

Bulloch, Blake ^{[6
]}

Agrawal, Dewesh ^{[7
]}

Saunders, Mary ^{[8
]}

Sutherland, Donna M. ^{[9
]}

Blackstone, Mercedes M. ^{[10
]}

Sarnaik, Amit ^{[12
]}

McManemy, Julie ^{[13
]}

Brent, Alison ^{[14
]}

Bennett, Jonathan ^{[11
]}

Plymale, Jennifer M. ^{[16
,17
]}

Solari, Patrick ^{[15
]}

Mann, Deborah J. ^{[23
]}

Dayan, Peter S. ^{[1
]}

机构：

[1] Columbia Univ Coll Phys & Surg, Dept Pediat Emergency Med, Morgan Stanley Childrens Hosp New York, New York, NY 10032 USA

[2] Texas Childrens Hosp, Baylor Coll Med, Houston, TX 77030 USA

[3] Childrens Hosp & Res Ctr, Oakland, CA USA

[4] Univ Texas SW, Childrens Med Ctr, Georgetown, Guyana

[5] Miami Childrens Hosp, Miami, FL USA

[6] Univ Arizona, Coll Med, Phoenix Childrens Hosp, Phoenix, AZ USA

[7] Childrens Natl Med Ctr, George Washington Sch Med, Washington, DC 20010 USA

[8] Med Coll Wisconsin, Childrens Hosp Wisconsin, Milwaukee, WI 53226 USA

[9] WakeMed Hlth, Raleigh, NC USA

[10] Univ Penn, Childrens Hosp Philadelphia, Sch Med, Philadelphia, PA 19104 USA

[11] Thomas Jefferson Univ, Jefferson Med Coll, AI duPont Hosp Children, Philadelphia, PA 19107 USA

[12] Wayne State Univ, Childrens Hosp Michigan, Detroit, MI USA

[13] Washington Univ, Sch Med, St Louis Childrens Hosp, St Louis, MO 63110 USA

[14] Univ Colorado, Sch Med, Childrens Hosp, Denver, CO USA

[15] Univ Washington, Sch Med, Seattle Childrens Hosp, Seattle, WA USA

[16] Univ Calif Davis, Sch Med, Dept Emergency Med, Davis, CA 95616 USA

[17] Univ Calif Davis, Sch Med, Dept Pediat, Davis, CA 95616 USA

[18] Univ Toronto, Hosp Sick Children, Div Paediat Emergency Med, Toronto, ON M5G 1X8, Canada

[19] Univ Toronto, Hosp Sick Children, Dept Gastroenterol & Hepatol, Toronto, ON M5G 1X8, Canada

[20] Univ Toronto, Hosp Sick Children, Dept Nutr, Toronto, ON M5G 1X8, Canada

[21] Harvard Univ, Sch Med, Dept Pediat, Childrens Hosp Boston, Boston, MA 02115 USA

[22] Univ Calif San Diego, Dept Emergency Med, Rady Childrens Hosp, San Diego, CA 92103 USA

[23] SUNY Syracuse, Syracuse, NY USA

来源：

ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE | 2011年 / 165卷 / 07期

关键词：

VERY-LOW RISK; OUTPATIENT MANAGEMENT; ASEPTIC-MENINGITIS; BACTERIAL; CHILDREN; ANTIBIOTICS; PREVALENCE; RECEPTOR-4; FEVER; AGE;

D O I：

10.1001/archpediatrics.2011.104

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Objectives: To determine the prevalence of and to identify risk factors for sterile cerebrospinal fluid (CSF) pleocytosis in a large sample of febrile young infants with urinary tract infections (UTIs) and to describe the clinical courses of those patients. Design: Secondary analysis of a multicenter retrospective review. Setting: Emergency departments of 20 North American hospitals. Patients: Infants aged 29 to 60 days with temperatures of 38.0 degrees C or higher and culture-proven UTIs who underwent a nontraumatic lumbar puncture from January 1, 1995, through May 31, 2006. Main Exposure: Febrile UTI. Outcome Measures: Presence of sterile CSF pleocytosis defined as CSF white blood cell count of 10/mu L or higher in the absence of bacterial meningitis and clinical course and treatment (ie, presence of adverse events, time to defervescence, duration of parenteral antibiotic treatment, and length of hospitalization). Results: A total of 214 of 1190 infants had sterile CSF pleocytosis (18.0%; 95% confidence interval, 15.9%-20.3%). Only the peripheral white blood cell count was independently associated with sterile CSF pleocytosis, and patients with a peripheral white blood cell count of 15/mu L or higher had twice the odds of having sterile CSF pleocytosis (odds ratio, 1.97; 95% confidence interval, 1.32-2.94; P= .001). In the subset of patients at very low risk for adverse events (ie, not clinically ill in the emergency department and without a high-risk medical history), patients with and without sterile CSF pleocytosis had similar clinical courses; however, patients with CSF pleocytosis had longer parenteral antibiotics courses (median length, 4 days [interquartile range, 3-6 days] vs 3 days [interquartile range, 3-5 days]) (P= .04). Conclusion: Sterile CSF pleocytosis occurs in 18% of young infants with UTIs. Patients with CSF pleocytosis at very low risk for adverse events may not require longer treatment with antibiotics.

引用

页码：635 / 641

页数：7

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