The evolving relationship between COVID‐19 and serious bacterial infection evaluation in febrile neonates

Abstract

Aim The COVID‐19 omicron variant surge highlighted the evolving impact of COVID‐19. Febrile infants <60 days old are high risk for serious bacterial infections (SBI). This study evaluated the rate of SBI based on COVID‐19 infection. Methods We conducted a retrospective chart review at an urban, academic paediatric emergency department. The study enrolled infants 60 days old or less with documented fever. The primary outcome was SBI diagnosed by blood, urine, and/or cerebrospinal fluid cultures. We compared the rate of SBI between COVID‐19 groups with an omicron variant and 29‐ to 60‐day‐old subgroup analyses. Results Two hundred and thirty‐three (233) infants meet the criteria. The incidence of SBI was 18.7% in the COVID‐19 negative and 1.7% in the COVID‐19‐positive group which is statistically significant (p < 0.001). Omicron subgroup analysis did not achieve statistical significance (p = 0.62) while COVID‐19‐positive infants 29–60 days old had a statistically significant lower rate of SBI (p = 0.006). Conclusion The omicron variant surge provided an additional understanding of the impact of COVID‐19 on these high‐risk infants. These results can lead to decreased invasive testing and exposure to antibiotics as well as examine the utility of viral testing for risk stratification.

Issue highlights

“…Assessing febrile infants in emergency departments can be both difficult and stressful. Guernsey et al 2 examined the evolving impact of concurrent COVID‐19 infections on febrile infants under 60 days of age. They found that the rate of serious bacterial infections in infants with COVID‐19 was 1.7%.…”

The febrile infant: Is it COVID‐19 or a serious bacterial infection?

“…between COVID-19 and Serious Bacterial Infection Evaluation inFebrile Neonates" by Guernsey III et al addresses in the current issue of Acta Paediatrica 5. To assess the impact of COVID-19 on the rate of severe bacterial infections in febrile infants, they per-formedaretrospectivechartreviewof233infants<60 daysold.All patientspresentedwithfeveratthepaediatricemergencydepart-mentatMaimonidesMedicalCenter,Brooklyn,NYinthemiddleof the omicron outbreak during the 2021/22 winter season.…”

“…There are now several articles from both The United States and Europe published that seem to come to the same conclusion. COVID‐19 in infants <90 days often presents with fever as the only presenting symptom and when they test positive for SARS‐CoV‐2, the risk for a simultaneous serious bacterial infection is low, but not completely ruled out 5,7,8 …”

“…This is the weakness that the article “The Evolving Relationship between COVID‐19 and Serious Bacterial Infection Evaluation in Febrile Neonates” by Guernsey III et al addresses in the current issue of Acta Paediatrica 5 . To assess the impact of COVID‐19 on the rate of severe bacterial infections in febrile infants, they performed a retrospective chart review of 233 infants <60 days old.…”