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COVID-19 and Serious Bacterial Infection in Febrile Infants Less Than 60 Days Old
David Guernsey1, Matthew Pfeffer1, James Kimpo1
1Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York.
Insights
Febrile infants under 60 days old with COVID-19 had a significantly lower rate of serious bacterial infections (SBI) compared to those without the virus. This finding suggests SARS-CoV-2 status can aid in risk-stratifying young children for infections like UTI and bacteremia.
Area of Science:
- Pediatrics
- Infectious Diseases
- Virology
Background:
- The COVID-19 pandemic created uncertainty regarding SARS-CoV-2 impact on children.
- Febrile infants under 60 days old present a challenge for diagnosing serious bacterial infections (SBI).
- Existing data on SARS-CoV-2 and SBI in infants was unclear.
Purpose of the Study:
- To investigate the association between SARS-CoV-2 infection and SBI rates in febrile infants.
- To determine if COVID-19 status can be used to risk-stratify febrile infants for SBI.
- To compare SBI rates in SARS-CoV-2 positive versus negative infants.
Main Methods:
- Retrospective chart review and age-matched case-control study (March 2020-June 2021).
- Inclusion of febrile infants less than 60 days old, grouped by SARS-CoV-2 status.
- Diagnosis of SBI using blood, urine, and cerebrospinal fluid cultures.
Main Results:
- 164 infants analyzed: 30 COVID-19 positive, 134 COVID-19 negative.
- Significantly lower SBI rate in COVID-19 positive infants (0%) vs. negative (17.9%) (p=0.008).
- Statistical significance found for any SBI (p<0.001), UTI (p<0.001), and bacteremia (p<0.001) in age-matched analysis.
Conclusions:
- SARS-CoV-2 infection status is a useful factor in risk-stratifying febrile infants.
- Findings may help reduce invasive testing and antibiotic exposure in this age group.
- Low incidence of bacteremia and meningitis in infants warrants further research.
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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