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.
Subject(s)
Bacterial Infections , COVID-19 , Infant, Newborn , Infant , Child , Humans , Retrospective Studies , COVID-19/diagnosis , COVID-19/epidemiology , SARS-CoV-2 , Bacterial Infections/complications , Bacterial Infections/diagnosis , Bacterial Infections/epidemiologyABSTRACT
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.