Risk of Serious Bacterial Infections in Young Febrile Infants With COVID-19

Payson, Alison; Etinger, Veronica; Napky, Pablo; Montarroyos, Stephanie; Ruiz-Castaneda, Ana; Mestre, Marcos

doi:10.1097/pec.0000000000002380

Cited by 17 publications

(20 citation statements)

References 23 publications

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“…A few single-center studies have recently reported low rates of non–SARS-CoV-2 viral infections among young febrile infants during the pandemic. 7 , 15 Our multicenter study also found similar lower rates of viral infections during the pandemic.…”

Section: Discussionsupporting

confidence: 75%

Neonatal Fever in the COVID-19 Pandemic

et al. 2021

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Objectives A sepsis workup is recommended in young infants 56 days or younger with fever to rule out a serious bacterial infection (SBI). Given the reduction in non–severe acute respiratory syndrome - coronavirus 2 viral infections observed in multiple studies during the coronavirus diseases 2019 (COVID-19) pandemic, we sought to determine if the reduction in viral infections led to a change in the incidence of SBI in this vulnerable patient population. Methods We performed a multicenter, retrospective study of infants 56 days or younger presenting with fever to emergency departments of 6 community hospitals. We compared the incidence of SBIs, viral meningitis, and viral bronchiolitis during March 2020 to February 2021 (pandemic year) with the same calendar months in the 2 preceding years (prepandemic years). Results From March 2018 to February 2021, 543 febrile infants presented to the emergency departments, 95 during the pandemic year (March 2020 to February 2021) compared with 231 and 217 in the prepandemic years (March 2018 to February 2019 and March 2019 to February 2020, respectively). During the pandemic year, 28.4% of infants (27 of 95) were diagnosed with an SBI compared with 11.7% and 6.9% ( P < 0.001) in the prepandemic years (27 of 231 and 15 of 217, respectively). Five patients were diagnosed with bacterial meningitis over the 3-year period, 4 of them during the pandemic year (4 of 95 [4.2%]). Positivity for viral cerebrospinal fluid polymerase chain reaction during the pandemic year was 6.4% (3 of 47) compared with 20.8% (25 of 120) and 20.4% (23 of 113) in prepandemic years ( P = 0.070). During the pandemic year, 2.1% (2 of 95) febrile young infants were admitted with a comorbid diagnosis of bronchiolitis compared with 4.3% and 6.0% in the prepandemic years ( P = 0.310). Conclusions The COVID-19 pandemic led to an increase in the incidence of SBIs in febrile infants 56 days or younger, likely a result of reduction in non–severe acute respiratory syndrome - coronavirus 2 viral infections. Greater vigilance is thus warranted in the evaluation of febrile infants during the COVID-19 pandemic.

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Section: Discussionsupporting

confidence: 75%

Neonatal Fever in the COVID-19 Pandemic

et al. 2021

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“…Data on the prevalence of UTI and IBI among febrile infants with SARS-CoV-2 are even more limited. Several small studies conducted early in the pandemic reported a 0% to 7% UTI prevalence among SARS-CoV-2–positive infants younger than 90 days with a highly variable prevalence of bacteremia (0%-14%) and no cases of bacterial meningitis …”

Section: Discussionmentioning

confidence: 99%

“…reported a 0% to 7% UTI prevalence among SARS-CoV-2-positive infants younger than 90 days with a highly variable prevalence of bacteremia (0%-14%) and no cases of bacterial meningitis. [11][12][13][14] The ongoing COVID-19 pandemic, however, has created a unique opportunity to assess the prevalence of concomitant bacterial infection as the majority of infants presenting for care had SARS-CoV-2 testing when testing became widely available; 88% in our convenience sample were tested.…”

Section: Prevalence Of Ibi In Sars-cov-2-positive Infants By Normal V...mentioning

confidence: 99%

Prevalence of Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Infants Aged 8 to 60 Days With SARS-CoV-2

et al. 2023

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ImportanceThe prevalence of urinary tract infection (UTI), bacteremia, and bacterial meningitis in febrile infants with SARS-CoV-2 is largely unknown. Knowledge of the prevalence of these bacterial infections among febrile infants with SARS-CoV-2 can inform clinical decision-making.ObjectiveTo describe the prevalence of UTI, bacteremia, and bacterial meningitis among febrile infants aged 8 to 60 days with SARS-CoV-2 vs without SARS-CoV-2.Design, Setting, and ParticipantsThis multicenter cross-sectional study was conducted as part of a quality improvement initiative at 106 hospitals in the US and Canada. Participants included full-term, previously healthy, well-appearing infants aged 8 to 60 days without bronchiolitis and with a temperature of at least 38 °C who underwent SARS-CoV-2 testing in the emergency department or hospital between November 1, 2020, and October 31, 2022. Statistical analysis was performed from September 2022 to March 2023.ExposuresSARS-CoV-2 positivity and, for SARS-CoV-2–positive infants, the presence of normal vs abnormal inflammatory marker (IM) levels.Main Outcomes and MeasuresOutcomes were ascertained by medical record review and included the prevalence of UTI, bacteremia without meningitis, and bacterial meningitis. The proportion of infants who were SARS-CoV-2 positive vs negative was calculated for each infection type, and stratified by age group and normal vs abnormal IMs.ResultsAmong 14 402 febrile infants with SARS-CoV-2 testing, 8413 (58.4%) were aged 29 to 60 days; 8143 (56.5%) were male; and 3753 (26.1%) tested positive. Compared with infants who tested negative, a lower proportion of infants who tested positive for SARS-CoV-2 had UTI (0.8% [95% CI, 0.5%-1.1%]) vs 7.6% [95% CI, 7.1%-8.1%]), bacteremia without meningitis (0.2% [95% CI, 0.1%-0.3%] vs 2.1% [95% CI, 1.8%-2.4%]), and bacterial meningitis (&lt;0.1% [95% CI, 0%-0.2%] vs 0.5% [95% CI, 0.4%-0.6%]). Among infants aged 29 to 60 days who tested positive for SARS-CoV-2, 0.4% (95% CI, 0.2%-0.7%) had UTI, less than 0.1% (95% CI, 0%-0.2%) had bacteremia, and less than 0.1% (95% CI, 0%-0.1%) had meningitis. Among SARS-CoV-2–positive infants, a lower proportion of those with normal IMs had bacteremia and/or bacterial meningitis compared with those with abnormal IMs (&lt;0.1% [0%-0.2%] vs 1.8% [0.6%-3.1%]).Conclusions and RelevanceThe prevalence of UTI, bacteremia, and bacterial meningitis was lower for febrile infants who tested positive for SARS-CoV-2, particularly infants aged 29 to 60 days and those with normal IMs. These findings may help inform management of certain febrile infants who test positive for SARS-CoV-2.

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“…10,11 Recently published data evaluating the effect of SARS-CoV-2 infection on the risk for SBI has yielded similar results. 12 The emergence of a new infectious disease presents challenges in the risk assessment of any patient, but particularly in this age group. Our goal in this paper was to identify the rate of SBI in febrile infants less than 60 days old presenting to the ED who were COVID-19 positive and then compare it to the rate of SBI in febrile infants less than 60 days old who were COVID-19 negative.…”

Section: How Does This Improve Population Health?mentioning

confidence: 99%

“… 10 , 11 Recently published data evaluating the effect of SARS-CoV-2 infection on the risk for SBI has yielded similar results. 12 …”

Section: Introductionmentioning

confidence: 99%

COVID-19 and Serious Bacterial Infection in Febrile Infants Less Than 60 Days Old

Guernsey

Pfeffer

Kimpo

et al. 2022

WestJEM

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Introduction: The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to the coronavirus disease 2019 (COVID-19) pandemic that drastically impacted the United States. The evidence was not clear on how SARS-CoV-2 infection impacted children, given the high prevalence of SAR-CoV-2 infection. Febrile infants less than 60 days old are an ongoing challenge to risk-stratify for serious bacterial infection (SBI), including urinary tract infection (UTI), bacteremia, and meningitis. We hypothesized there would be a lower rate of SBI in SARS-CoV-2 positive febrile infants compared to those SARS-CoV-2 negative. Methods: This was a retrospective chart review with a nested, age-matched, case-control study performed from March 2020–June 2021. Infants less than 60 days old presenting with fever were assigned groups based on SARS-CoV-2 infection. Blood, urine, and cerebrospinal fluid cultures were used as the gold standard to diagnose SBI. We compared overall rate of SBI as well as individual rates of SBI between each group. We performed a subgroup analysis evaluating the age group 29-60 days old. Results: A total of 164 subjects met criteria for analysis: 30 COVID-19 positive and 134 COVID-19 negative subjects. Rate of SBI was 17.9% (95% confidence interval [CI]: 11.8-25.5%) in the COVID-19 negative group compared to 0% (95% CI: 0.0%-11.1%) in the COVID-19 group, which demonstrated statistical significance (p = 0.008). In the age-matched data, we found statistical significance for any SBI (p = <0.001). For individual rates of SBI, we found statistical significance for UTI (p = <0.001) and bacteremia (p = <0.001). The 29- 60 days-old subgroup analysis did not achieve statistical significance (p = 0.11). Conclusion: This study demonstrated the utility of including SARS-CoV-2 infection as part of the risk stratification of febrile infants less than 60 days old. While overall there is a low incidence of bacteremia and meningitis in this age group, these results can contribute to existing literature and potentially help decrease invasive testing and exposure to broad-spectrum antibiotics.

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Risk of Serious Bacterial Infections in Young Febrile Infants With COVID-19

Cited by 17 publications

References 23 publications

Neonatal Fever in the COVID-19 Pandemic

Neonatal Fever in the COVID-19 Pandemic

Prevalence of Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Infants Aged 8 to 60 Days With SARS-CoV-2

COVID-19 and Serious Bacterial Infection in Febrile Infants Less Than 60 Days Old

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