Bacterial coinfection in young febrile infants with SARS-CoV-2 infection
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Cited by 3 publications
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Management of Febrile Infants Under 3 Months of Age with SARS-CoV-2 Infection in the Emergency Department
Objective Febrile infants with a proven viral infection are at lower risk for a potentially serious bacterial infection (SBI). Our objective is to describe the management of young febrile infants with COVID-19 in the emergency department. Methods Febrile infants <3 months with a positive PCR (polymerase chain reaction) test for SARS-CoV-2 between March 2020 and October 2022 were included in a cross-sectional study. The indication for complementary tests, hospital admission and antibiotic therapy was analyzed. We performed a global analysis and by age subgroups (<29 d and ≥29 d). Results A total of 172 patients were included in the study, out of which 32 (18.6%) were <29 days old. Bacterial cultures were performed on 160 patients (93%), with urine cultures being the most frequently requested (151 patients; 87.8%). Overall, 39 infants (22.7%) were hospitalized, and 17 infants (9.9%) received antibiotics. In the subgroup analysis, patients <29 days had performed more frequently urine culture (100 vs. 85%; p = 0.015), blood culture (96.9 vs. 43.6%; p < 0.001), and cerebrospinal fluid culture (18.8 vs. 1.4%; p < 0.001). They also had a higher admission rate (68.8 vs. 12.1%; p < 0.001) and antibiotic prescription (21.9 vs. 7.1%; p = 0.02). SBI was identified in 10 patients (9 with urinary infections and 1 with bacteremia), while no invasive bacterial infection (IBI) was diagnosed in patients aged ≥29 days. Conclusions The identification of SARS-CoV-2 led to less aggressive management in a significant number of cases compared with usual practice. The low prevalence of IBI would support its inclusion in the management algorithms for febrile infants, especially in patients aged ≥29 days. The nonnegligible prevalence of urinary infection would make it necessary to maintain its screening.
Management of Febrile Infants Under 3 Months of Age with SARS-CoV-2 Infection in the Emergency Department
Objective Febrile infants with a proven viral infection are at lower risk for a potentially serious bacterial infection (SBI). Our objective is to describe the management of young febrile infants with COVID-19 in the emergency department. Methods Febrile infants <3 months with a positive PCR (polymerase chain reaction) test for SARS-CoV-2 between March 2020 and October 2022 were included in a cross-sectional study. The indication for complementary tests, hospital admission and antibiotic therapy was analyzed. We performed a global analysis and by age subgroups (<29 d and ≥29 d). Results A total of 172 patients were included in the study, out of which 32 (18.6%) were <29 days old. Bacterial cultures were performed on 160 patients (93%), with urine cultures being the most frequently requested (151 patients; 87.8%). Overall, 39 infants (22.7%) were hospitalized, and 17 infants (9.9%) received antibiotics. In the subgroup analysis, patients <29 days had performed more frequently urine culture (100 vs. 85%; p = 0.015), blood culture (96.9 vs. 43.6%; p < 0.001), and cerebrospinal fluid culture (18.8 vs. 1.4%; p < 0.001). They also had a higher admission rate (68.8 vs. 12.1%; p < 0.001) and antibiotic prescription (21.9 vs. 7.1%; p = 0.02). SBI was identified in 10 patients (9 with urinary infections and 1 with bacteremia), while no invasive bacterial infection (IBI) was diagnosed in patients aged ≥29 days. Conclusions The identification of SARS-CoV-2 led to less aggressive management in a significant number of cases compared with usual practice. The low prevalence of IBI would support its inclusion in the management algorithms for febrile infants, especially in patients aged ≥29 days. The nonnegligible prevalence of urinary infection would make it necessary to maintain its screening.
The frequency of serious bacterial infection in febrile infants less than 90 days infected with SARS-CoV-2 and other respiratory viral pathogens
Background The primary aim of this study was to compare the groups, SARS-CoV-2-positive and -negative patients, in terms of the frequency of SBI. The SARS-CoV-2-positive group was compared with the other-RVPs-positive group as a secondary evaluation in terms of serious bacterial infection (SBI). Methods This retrospective multicenter cohort study was conducted at four university hospitals from March 2020 to December 2021. Patients under 90 days old, with a measured fever of ≥ 38 °C, who were tested for SARS-CoV-2 and had blood and urine cultures taken, were included in the study. The patient groups who tested positive and negative for SARS-CoV-2 were compared regarding clinical characteristics, laboratory data, and the frequency of serious bacterial infections. As a secondary analysis, among patients tested for other respiratory viruses, the SARS-CoV-2-positive group and other respiratory virus-positive groups were compared in terms of the frequency of SBI. Results A total of 208 patients met the inclusion criteria. Two distinct comparisons were conducted among the patients included in the study: the first between the SARS-CoV-2-positive and SARS-CoV-2-negative patient groups, and the second between the SARS-CoV-2-positive and other RVPs-positive patient groups. In the first comparison, fifty-five patients were SARS-CoV-2-positive and 153 were SARS-CoV-2-negative. The rate of SBI in the SARS-CoV-2-positive patients was 16.4%, whereas that in the SARS-CoV-2-negative patients was 47.1%. The laboratory parameters for infection suspicion were significantly lower in the SARS-CoV-2-positive group than the SARS-CoV-2-negative group. In the second comparison, 90 patients who were tested for both SARS-CoV-2 and other RVPs were evaluated. The mean WBC, ANC and CRP levels were significantly lower in the SARS-CoV-2-positive group than the other RVPs-positive group, however, there was no significant difference in the mean ALC, NLR and PCT levels and the frequency of SBI between the SARS-CoV-2-positive and other RVPs-positive patient groups. Conclusions These results suggest that febrile infants younger than 90 days with SARS-CoV-2 have lower rates of SBI than patients without SARS-CoV-2. These data are consistent with previous studies describing lower risks of SBI in febrile infants with RVPs. Trial registration Not applicable.
Severe and invasive bacterial infections in infants aged less than 90 days with and without SARS-CoV-2 infection
Background Fever in children represents one of the most common causes of medical evaluation. Infants younger than 90 days of age are at higher risk of severe and invasive bacterial infections (SBI and IBI). However, clinical signs and symptoms of viral and bacterial infections in young infants are frequently similar, and several studies have shown that the risk of SBIs remains non-negligible even in the presence of a positive point-of-care viral test. Our study aims to evaluate whether the proportion of SBIs and IBIs in febrile infants younger than 90 days during the COVID-19 pandemic was higher than that in the pre-pandemic period, and to describe the proportion of SBIs and IBIs in infants with and without SARS-CoV-2 infection. Methods This was a retrospective single-center cohort study conducted at the Children's Hospital of the University of Padua in Italy, involving febrile young infants evaluated in the Pediatric Emergency Department (PED) and admitted to Pediatric Acute Care Unit (PACU) between March 2017 to December 2022. Infants admitted before the COVID-19 pandemic were compared to infants admitted during the pandemic period and SARS-CoV-2 positive patients to the negative ones. Results 442 febrile infants younger than 90 days were evaluated in Padua PED and admitted to the wards. The proportion of SBIs and IBIS did not significantly change over the study periods, ranging between 10.8% and 32.6% (p = 0.117) and between 0% and 7.6%, respectively (p = 0.367). The proportion of infants with a diagnosis of SBIs and IBIs was higher in the SARS-CoV-2 negative group (30.3% and 8.2%, respectively) compared to the positive group (8.5% and 2.8%, respectively) (p < 0.0001). The most common diagnosis in both groups was UTI, mainly caused by E. coli. A similar proportion of blood and urine cultures were performed, whereas lumbar puncture was more frequently performed in SARS-CoV-2 negative infants (40.2% vs 16.9%, p = 0.001). Conclusions Although the risk of concomitant serious bacterial infection with SARS-CoV-2 is low, it remains non-negligible. Therefore, even in SARS-CoV-2-positive febrile infants, we suggest that the approach to screening for SBIs remains cautious.
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