Prevalence of Meningitis among Hospitalized Neonates with Urinary Tract Infection

Document Type : Original Article


1 Department of Pediatrics, Akbarabadi Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran

2 Department of Genetics, Akbarabadi Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran

3 Department of Pediatrics, Ali Asghar Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran

4 Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran


Background: Bacteremia is relatively common in children with urinary tract infection (UTI). The aim of the present study was to determine the frequency of bacterial meningitis among neonates with laboratory-confirmed UTI.
Methods: This retrospective cross-sectional study was performed on 163 hospitalized neonates in Ali Asghar and Shahid Akbarabadi hospitals affiliated to Iran University of Medical Sciences in Tehran, Iran. The demographic and clinical data of hospitalized neonates due to UTI during the recent 6 years (2010-2016) who were aged < 28 days and had cerebrospinal fluid (CSF) culture via lumbar puncture were extracted from medical records and recorded in some checklists.
Results: A total of 163 neonates with laboratory-confirmed UTI with the mean age of 18.25±5.41 days were included. In this study, 54% of the neonates were male. Out of all neonates, 23 (14.1%) cases had positive blood culture. The positive CSF culture was observed in only two (1.2%) neonates. Positive voiding cystourethrogram (VCUG) test was reported in 50% of the neonates with positive CSF culture (P=0.047). Although abnormal ultrasound findings related to the urinary tract in positive CSF neonates were higher by approximately twofold, compared to those reported for negative CSF neonates, this difference was not statistically significant (50% and 24.2%, respectively; P=0.432).
Conclusion: The frequency of the concurrent occurrence of UTI and meningitis in our neonates was 1.2%. Out of all indicators associated with meningitis occurrence, positive VCUG may be a risk factor. Further prospective studies are needed to approve these results.


1. Najar MS, Saldanha CL, Banday KA. Approach to urinary tract infections. Indian J Nephrol. 2009; 19(4):129-39.
2. Foxman B. The epidemiology of urinary tract infection. Nature Rev Urol. 2010; 7(12):653-60.
3. Nickavar A, Sotoudeh K. Treatment and prophylaxis in pediatric urinary tract infection. Int J Prev Med. 2011; 2(1):4-9.
4. Weisz D, Seabrook JA, Lim RK. The presence of urinary nitrites is a significant predictor of pediatric urinary tract infection susceptibility to first- and third-generation cephalosporins. J Emerg Med. 2010; 39(1):6-12.
5. Rowe TA, Juthani-Mehta M. Urinary tract infection in older adults. Aging Health. 2013; 9(5):38.
6. Robinson JL, Finlay JC, Lang ME, Bortolussi R. Urinary tract infections in infants and children: diagnosis and management. Paediatr Child Health. 2014; 19(6):315-25.
7. Wallace SS, Brown DN, Cruz AT. Prevalence of concomitant acute bacterial meningitis in neonates with febrile urinary tract infection: a retrospective cross-sectional study. J Pediatr. 2017; 184:199-203.
8. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012; 10:CD001321.
9. Newman DK, Wein AJ. Office-based behavioral therapy for management of incontinence and other pelvic disorders. Urol Clin North Am. 2013; 40(4):613-35.
10. Bachur R, Caputo GL. Bacteremia and meningitis among infants with urinary tract infections. Pediatr Emerg Care. 1995; 11(5):280-4.
11. Barkemeyer BM. Suprapubic aspiration of urine in very low birth weight infants. Pediatrics. 1993; 92(3):457-9.
12. Paquette K, Cheng MP, McGillivray D, Lam C, Quach C. Is a lumbar puncture necessary when evaluating febrile infants (30 to 90 days of age) with an abnormal urinalysis? Pediatr Emerg Care. 2011; 27(11):1057-61.
13. Zorc JJ, Kiddoo DA, Shaw KN. Diagnosis and management of pediatric urinary tract infections. Clin Microbiol Rev. 2005; 18(2):417-22.
14. Schnadower D, Kuppermann N, Macias CG, Freedman SB, Baskin MN, Ishimine P, et al. Febrile infants with urinary tract infections at very low risk for adverse events and bacteremia. Pediatrics. 2010;
15. Syrogiannopoulos GA, Grivea IN, Anastassiou ED, Triga MG, Dimitracopoulos GO, Beratis NG. Sterile cerebrospinal fluid pleocytosis in young infants with urinary tract infection. Pediatr Infect Dis J. 2001; 20(10):927-30.
16. Tebruegge M, Pantazidou A, Clifford V, Gonis G, Ritz N, Connell T, et al. The age-related risk of co-existing meningitis in children with urinary tract infection. PloS One. 2011; 6(11):e26576.
17. Dayan PS, Hanson E, Bennett JE, Langsam D, Miller SZ. Clinical course of urinary tract infections in infants younger than 60 days of age. Pediatr Emerg Care. 2004; 20(2):85-8.
18. Vuillermin PJ, Starr M. Investigation of the rate of meningitis in association with urinary tract infection in infants 90 days of age or younger. Emerg Med Australas. 2007; 19(5):464-9.
19. Bonadio WA, Smith DS, Goddard S, Burroughs J, Khaja G. Distinguishing cerebrospinal fluid abnormalities in children with bacterial meningitis and traumatic lumbar puncture. J Infect Dis. 1990;
20. Goldman RD, Matlow A, Linett L, Scolnik D. What is the risk of bacterial meningitis in infants who present to the emergency department with fever and pyuria? CJEM. 2003; 5(6):394-9.
21. Ku LC, Boggess KA, Cohen-Wolkowiez M. Bacterial meningitis in infants. Clin Perinatol. 2015; 42(1): 29-45.
22. Khalessi N, Afsharkhas L. Neonatal meningitis: risk factors, causes, and neurologic complications. Iran J Child Neurol. 2014; 8(4):46-50.
23. Shah SS, Zorc JJ, Levine DA, Platt SL, Kuppermann N. Sterile cerebrospinal fluid pleocytosis in young infants with urinary tract infections. J Pediatr. 2008; 153(2):290-2.
24. Kim JH, Lee JH. A necessity for lumbar puncture and VCUG in febrile UTI infants less than 3 months of age. J Korean Soc Pediatr Nephrol. 2009; 13(1):33-9.
25. Gupta A, Garg RK, Singh MK, Verma R, Malhotra HS, Sankhwar SN, et al. Bladder dysfunction and urodynamic study in tuberculous meningitis. J Neurol Sci. 2013; 327(1-2):46-54.