{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T02:22:37Z","timestamp":1783390957353,"version":"3.54.6"},"reference-count":30,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,1]]},"abstract":"<jats:sec><jats:title\/><\/jats:sec><jats:sec><jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title><jats:p>To determine factors associated with cerebrospinal fluid (CSF) testing in febrile young infants with a positive urinalysis and assess the probability of delayed diagnosis of bacterial meningitis in infants treated for urinary tract infection (UTI) without CSF testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>We performed a retrospective cohort study using data from the Reducing Excessive Variability in Infant Sepsis Evaluation quality improvement project. A total of 20\u2009570 well-appearing febrile infants 7 to 60 days old presenting to 124 hospitals from 2015 to 2017 were included. A mixed-effects logistic regression was conducted to determine factors associated with CSF testing. Delayed meningitis was defined as a new diagnosis of bacterial meningitis within 7 days of discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Overall, 3572 infants had a positive urinalysis; 2511 (70.3%) underwent CSF testing. There was wide variation by site, with CSF testing rates ranging from 64% to 100% for infants 7 to 30 days old and 10% to 100% for infants 31 to 60 days old. Factors associated with CSF testing included: age 7 to 30 days (adjusted odds ratio [aOR]: 4.6; 95% confidence interval [CI]: 3.8\u20135.5), abnormal inflammatory markers (aOR: 2.2; 95% CI: 1.8\u20132.5), and site volume &amp;gt;300 febrile infants per year (aOR: 1.8; 95% CI: 1.2\u20132.6). Among 505 infants treated for UTI without CSF testing, there were 0 (95% CI: 0%\u20130.6%) cases of delayed meningitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>There was wide variation in CSF testing in febrile infants with a positive urinalysis. Among infants treated for UTI without CSF testing (mostly 31 to 60-day-old infants), there were no cases of delayed meningitis within 7 days of discharge, suggesting that routine CSF testing of infants 31 to 60 days old with a positive urinalysis may not be necessary.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2018-3979","type":"journal-article","created":{"date-parts":[[2019,8,8]],"date-time":"2019-08-08T12:25:12Z","timestamp":1565267112000},"source":"Crossref","is-referenced-by-count":14,"title":["Testing for Meningitis in Febrile Well-Appearing Young Infants With a Positive Urinalysis"],"prefix":"10.1542","volume":"144","author":[{"given":"Marie E.","family":"Wang","sequence":"first","affiliation":[{"name":"Division of Pediatric Hospital Medicine, Department of Pediatrics, Lucile Packard Children\u2019s Hospital Stanford and School of Medicine, Stanford University, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A.","family":"Biondi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hospital Medicine, Johns Hopkins Children\u2019s Center and School of Medicine, Johns Hopkins University, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell J.","family":"McCulloh","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hospital Medicine, University of Nebraska Medical Center and Children\u2019s Hospital and Medical Center, Omaha, Nebraska;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D.","family":"Garber","sequence":"additional","affiliation":[{"name":"Division of Hospital Pediatrics, Department of Pediatrics, College of Medicine, University of Florida, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth C.","family":"Natt","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, Connecticut; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian P.","family":"Lucas","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice and Department of Medicine, School of Medicine, Dartmouth College, Hanover, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan R.","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hospital Medicine, Department of Pediatrics, Lucile Packard Children\u2019s Hospital Stanford and School of Medicine, Stanford University, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2019,9,1]]},"reference":[{"issue":"3","key":"2021121014054891300_B1","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1056\/NEJMra1007755","article-title":"Febrile urinary tract infections in children","volume":"365","author":"Montini","year":"2011","journal-title":"N Engl J Med"},{"issue":"1","key":"2021121014054891300_B2","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/S0022-3476(05)80591-8","article-title":"Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone","volume":"120","author":"Baskin","year":"1992","journal-title":"J Pediatr"},{"issue":"20","key":"2021121014054891300_B3","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1056\/NEJM199311113292001","article-title":"Outpatient management without antibiotics of fever in selected infants","volume":"329","author":"Baker","year":"1993","journal-title":"N Engl J Med"},{"issue":"3","key":"2021121014054891300_B4","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1542\/peds.94.3.390","article-title":"Febrile infants at low risk for serious bacterial infection\u2013an appraisal of the Rochester criteria and implications for management. 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