SERIOUS BACTERIAL-INFECTIONS IN FEBRILE INFANTS AND CHILDREN SELECTEDFOR LUMBAR PUNCTURE

Lumbar puncture (LP) is performed frequently in pediatric emergency de partments to diagnose meningitis in infants and young children with fe ver. Children selected to have LP who do not have meningitis may, howe ver, have other serious bacterial infections. We surveyed lumbar punct ures performed in the Boston City Hospital Pediatric Emergency Departm ent and monitored the incidence of meningitis and other serious bacter ial infections. Meningitis was diagnosed in 8% of children who underwe nt LP. An additional 10.5% of children who underwent LP and had normal cerebrospinal fluid had positive cultures of blood (3.1%), urine (4.1 %) or stool (3.3%). The decision to perform lumbar puncture identifies children at risk of having not only meningitis but other serious bact erial illnesses. Those children 2 years of age and younger with normal cerebrospinal fluid should be considered for cultures of blood, urine and possibly stool.