Management of Febrile Infants Under 3 Months of Age with SARS-CoV-2 Infection in the Emergency Department

Abstract

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.