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COVID Positive Febrile Infants – Do We Need SBI Workup?

May 20, 2021

Written by Clay Smith

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Febrile infants <90 days who were COVID positive had lower rates of serious bacterial infection (SBI) when compared to age and gender matched COVID negative febrile infants.

Why does this matter?
We know SBI is less prevalent among RSV or influenza positive infants. Would the same be true of COVID+ infants?

Is COVID the culprit?
This was a retrospective study at a single center that included 53 COVID(+) febrile infants <90 days compared with 53 age and gender matched febrile controls who were COVID negative. They found the risk of SBI (UTI, bacterial enteritis, bacteremia, or bacterial meningitis) was much lower in COVID(+) infants 8% vs 34%. The most common SBI was UTI, 6% COVID(+) vs 23% COVID(-). There were no cases of bacteremia or meningitis among COVID(+) infants. Rates of SBI were higher in this study than in past papers. However, this was in the midst of the pandemic when patients were only brought in by parents if absolutely necessary, which may have skewed these numbers toward higher acuity. COVID(+) infants more often had respiratory symptoms and had lower WBC counts and CRP than controls. This provides some reassurance that infants who test positive for COVID-19 are less likely to have SBI, but I don’t think we can completely avoid a workup based on this single center, small, retrospective study.

Risk of Serious Bacterial Infections in Young Febrile Infants With COVID-19. Pediatr Emerg Care. 2021 Apr 1;37(4):232-236. doi: 10.1097/PEC.0000000000002380.

What are your thoughts?