A 6-week-old girl is admitted with fevers, vomiting and a urine dipstick suggestive of a urinary tract infection (UTI). Inflammatory markers and blood culture are sent to the laboratory, and she is commenced on empirical intravenous antibiotics. The following day, her blood culture flagged positive. It is known that the risk of meningitis in well-appearing infants and children (>4 weeks old) with UTI is low, and a routine lumbar puncture (LP) is not required. But, in the setting of bacteraemia, is an LP now warranted?

In infants with bacteraemic UTI, is an LP required to exclude meningitis?

A literature search was conducted on OVID MEDLINE up to 26 December 2023 using the following strategy: (paediatric* or paediatric* or child* or infan* or newborn or neonat*) AND (UTI or urinary tract adj4 infec* or urinary adj3 infec* or bacteriuria or urinalysis or cystitis) AND (sepsis or septic* or bacteraemi* or bacteremi* or meningiti* or encephaliti* or meningoencephalitis or lumbar puncture* or spinal puncture* or spinal tap* or cerebrospinal fluid or CSF). Results were restricted to the year 2000 onwards.

1593 unique articles were identified and screened for title and abstract. Articles were included if the study was in children <18 years old and …