Annual Trend in Lumbar Puncture for Infants Younger Than 3 Months Hospitalized With Suspected Serious Bacterial Infection: A Nationwide Inpatient Database Study.

Abstract

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 purpose of this study was to identify the annual trend in the proportion of lumbar punctures in infants with suspected serious bacterial infections using a national inpatient database in Japan. Using the Diagnosis Procedure Combination database, we identified infants < 3 months of age who underwent blood and urine culture tests on admission from April 2011 to March 2020 in Japan. In total, 44,910 eligible infants were included in the study. The proportion of lumbar punctures decreased gradually from 57.9% to 50.4% in infants 4-28 days old and from 54.5% to 37.3% in infants 29-89 days old between 2011 and 2019. Of the 18 hospitals, 15 (83.3%) recorded a lumbar puncture proportion of >50% in 2011 and 7 (38.9%) recorded >50% in 2019. In 3 hospitals, the proportion of lumbar punctures remained >75% in 2019. The proportion of lumbar punctures with hospitalized infants admitted with blood and urine culture tests decreased over the years, and this trend was greater in infants 29-89 days of age. The reduction in the proportion of lumbar punctures varied widely among the hospitals.