Lumbar puncture use and antibiotic treatment in newly admitted febrile children following index cases of invasive infections

Background Bacterial meningitis (BM) and meningococcal sepsis are rare but serious infectious events in childhood. Despite the availability of validated decision tools and guidelines, clinical practice may be influenced by subjective risk perception, in particular after rare, high-impact events. This study investigated whether in-hospital cases of BM or meningococcal sepsis were associated with changes in lumbar puncture (LP) frequency or empirical antibiotic use among subsequently evaluated febrile infants and children. Methods We performed a retrospective single-center study of pediatric inpatients (29 days to 18 years) undergoing LP between January 2019 and December 2024. Clinical, microbiological, and treatment data were analyzed, and the Bacterial Meningitis Score (BMS) was calculated. Multilevel logistic regression models assessed associations between events of BM or meningococcal sepsis, LP frequency, and antibiotic treatment for suspected BM. Results Of 30,967 inpatients, 269 LPs were performed for suspected BM. Five cases of BM were identified, viral pathogens were detected in 24 patients. LP frequency increased significantly in a 4-month period following a BM or meningococcal sepsis case that occurred at the hospital (OR = 2.06, 95% 0.96, 4.45), but not in subsequent months. There was no corresponding increase in antibiotic therapy observed. Both younger age and non-negative BMS were associated with receiving BM-targeted antibiotics. Conclusions Rare invasive infectious events were associated with a short-term rise in LP use but not with increased antibiotic treatment, suggesting a transient shift in diagnostic behavior. These findings highlight the need to address cognitive influences on clinical decision-making and to reinforce structured diagnostic pathways and antimicrobial stewardship. Clinical trial number Not applicable.