Background/Objectives: Our objectives were to determine the prevalence of co-existing bacterial meningitis (BM) and sterile cerebral spinal fluid (CSF) pleocytosis in the presence of Escherichia coli urinary tract infection (UTI) in children age zero days to two years, with the addition of CSF E. coli Polymerase Chain Reaction (PCR) analysis. Subjects/Methods: A retrospective study was conducted at a tertiary referral paediatric hospital from 1/1/2014 to 30/4/2019. Co-existing E. coli BM with UTI was defined as a pure growth E. coli from urine and a CSF culture with pure growth of E. coli and/or positive E. coli PCR. All children with a pure growth of E. coli from a urine sample and a CSF sample taken 48 hours before or after a positive urine culture were included. Further PCR analysis was carried out in cases with CSF pleocytosis. Results: There were 1911 patients that met the definition for an E. coli UTI, of which 314 had a CSF taken within 48 hours. No cases of co-existing E. coli meningitis were identified. Overall, there were 71 (23%) cases of pleocytosis, 57 (80%) of these had further PCR analysis, all of which were E. coli PCR not detected. Conclusion: The risk of E. coli UTI and co-existing E. coli BM is low. Routine lumber punctures (LPs) could be avoided in well-appearing infants with a diagnosis of E. coli UTI with the greatest impact seen in children up to 6 months of age. CSF E. coli PCR can help to further reduce the post-test probability of meningitis in the setting of pleocytosis. Funding Statement: None. Declaration of Interests: All authors declare that they have no conflicts of interest. Ethics Approval Statement: The study was reviewed and approved by the CHI Temple Street Scientific and Ethics Committee [REC Reference 19·007].