Lumbar puncture rate drops in infants with suspected serious bacterial infection

Over the years, the percentage of lumbar punctures has declined among hospitalized infants admitted with suspected serious bacterial infection and had blood and urine culture tests. Such a trend is more prominent among those aged 29‒89 days, according to a Japan study.

In addition, the decrease in the proportion of lumbar punctures greatly differ among hospitals.

Lead author Yasuyuki Fuseda, from Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan, and his team conducted this nationwide inpatient database study to identify the annual proportion of lumbar punctures in infants with suspected serial bacterial infections.

The authors used the Diagnosis Procedure Combination database and identified infants <3 months of age who underwent blood and urine culture tests on admission from April 2011 to March 2020 in Japan.

A total of 44,910 infants met the eligibility criteria of the study. Between 2011 and 2019, the proportion of lumbar punctures steadily dropped from 57.9 percent to 50.4 percent in infants aged 4‒28 days and from 54.5 percent to 37.3 percent in those aged 29‒89 days.

Fifteen of the 18 hospitals (83.3 percent) recorded a lumbar puncture proportion of >50 percent in 2011, while seven recorded >50 percent in 2019. In three hospitals, however, the proportion of lumbar punctures remained >75 percent in 2019.

“A lumbar puncture is no longer necessary in febrile infants younger than 3 months when they are at low risk of serious bacterial infection because the risk factors for a severe bacterial infection have been identified,” the authors said.