Coexisting bacterial meningitis with urinary tract infection in children less than 5 years old in central child teaching hospital

Objective: To determine age-stratified prevalence of concomitant bacterial meningitis in children <5 years with a urinary tract infection, to determine the prevalence of invasive UTI and risk of meningitis following bacteremia. Method: we performed a case series study on patients admitted to our hospital suffering from UTIaged < 5 years old in the central child teaching hospital from April to November 2018. UTI was defined as a urine culture growing ≥10 000 colony-forming units/ml of a single organism from a catheterized specimen or ≥100 000 colony-forming units/ml of a single organism from a bagged urine specimen. Meningitis was defined as cerebrospinal fluid with >35 WBC /mm3 in infants ≤ one month of age or with >10 WBC /mm3 in infants >1 month of age. Results: Of 100 infants with UTI, a lumbar puncture was performed in 29, and 22 (75%) hadmeningitis. In 11 patients (11%) the meningitis followed UTI while in another 11 patients with meningitis, the UTI was discovered during septic screen.10 patients had bacteremia and 7 of them (70%) developed meningitis. Of 12 patients aged < 1month in the study population (75%) got meningitis together with UTI, the most prevalent isolated pathogen in study population was E. coli in urine (60%) and blood (27%) most of them (54%) were multiple drug resistant infection. 24% of patients with undernutrition developed meningitis. Neutropenia found to be significantly associated with getting gram negative meningitis (p value= 0.001), there was significant association between fever and meningitis (p value= 0.032) but no significant association with gender or anemia (p value = 0.216, 0.791) respectively. Conclusion: The clinicians should have a low threshold to perform a lumbar puncture in neonates with UTI, as the risk of getting meningitis is not insignificant in this age group. UTI is a serious infection, and when treated, it should be treated carefully because in most of our cases the isolated pathogen was resistant to the traditional treatment prescribed by physicians, and neutropenia refers indirectly that the patient may develop sever infections.