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Updated: Jun 17, 2025
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Severe and invasive bacterial infections in infants aged less than 90 days with and without SARS-CoV-2 infection
Giulia Brigadoi1, Francesca Tirelli2,3, Sara Rossin2
1Department of Women's and Children' Health, Pediatric Infectious Disease Unit, Padua University, Padua, Italy. giulia.brigadoi@phd.unipd.it.
Insights
The proportion of serious bacterial infections (SBIs) and invasive bacterial infections (IBIs) in febrile infants under 90 days did not change during the COVID-19 pandemic. However, SBIs and IBIs were less common in infants with SARS-CoV-2 infection compared to those without.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Fever in infants under 90 days necessitates medical evaluation due to high risk of serious bacterial infections (SBIs) and invasive bacterial infections (IBIs).
- Clinical presentation of viral and bacterial infections in young infants can be similar, complicating diagnosis.
- The risk of SBIs persists even with positive viral tests, highlighting diagnostic challenges.
Purpose of the Study:
- To compare the incidence of SBIs and IBIs in febrile infants under 90 days during the COVID-19 pandemic versus the pre-pandemic period.
- To determine the incidence of SBIs and IBIs in infants with and without SARS-CoV-2 infection.
Main Methods:
- Retrospective single-center cohort study at the Children's Hospital of the University of Padua, Italy.
- Involved febrile infants under 90 days evaluated between March 2017 and December 2022.
- Compared infants admitted before and during the COVID-19 pandemic, and SARS-CoV-2 positive versus negative cases.
Main Results:
- No significant change in the proportion of SBIs (10.8%-32.6%) and IBIs (0%-7.6%) between study periods.
- SBIs and IBIs were significantly lower in SARS-CoV-2 positive infants (8.5% and 2.8%) compared to negative infants (30.3% and 8.2%).
- Urinary tract infection (UTI) was the most common diagnosis in both groups; lumbar punctures were more frequent in SARS-CoV-2 negative infants.
Conclusions:
- The risk of concomitant serious bacterial infection with SARS-CoV-2 is low but not negligible.
- A cautious approach to screening for SBIs is recommended for all febrile infants, including those who test positive for SARS-CoV-2.
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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