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Infants 8-60 Days With COVID – What’s the Risk of SBI?

June 15, 2023

Written by Jason Lesnick

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Infants who tested positive for SARS-CoV-2 were less likely to have UTI, bacteremia, and bacterial meningitis. 

Why does this matter?
About 180,000 febrile infants < 90 days old are evaluated annually in US EDs. 7-10% of these patients have a UTI, 2-3% have bacteremia, and 0.5-1% have bacterial meningitis. Febrile infants with documented viral infections have a lower prevalence of bacterial infections than those who test negative, but this varies by virus and age. How would SARS-CoV-2 positivity influence the rates of bacterial infection in this population?

It’s just COVID – or is it?
This multinational cross-sectional study included a retrospective convenience sample of 14,402 febrile infants aged 8 to 60 days without bronchiolitis and with a temperature of at least 38° C (100.4° F) from 106 hospitals in the US and Canada from November 2020 until October 2022 who had SARS-CoV-2 testing done. 8,413 (56.5%) patients were aged 29-60 days in this study. 3,753 (26.1%) of patients tested positive for SARS-CoV-2. 

The authors analyzed the population by the American Academy of Pediatrics Clinical Practice Guidelines (AAP CPG) recommended inflammatory markers (IMs) and age groups (8-21 days, 22-28 days, and 29-60 days). 

Abnormal IMs were defined as: 

  • UA with positive leukocyte esterase, nitrite, or > 5 WBCs 
  • Max temp > 38.5° 
  • ANC > 4000 
  • CRP ≥ 2 mg/dl (often displayed as 20 mg/L) 
  • Procalcitonin > 0.5 ng/mL 

38 of 3,753 (1.0%, 95%CI 0.7%-1.3%) SARS-CoV-2 positive infants had a concomitant UTI or IBI (invasive bacterial infection – either bacteremia or meningitis), while 949 of 10,649 (8.9%, 95% CI 8.4%-9.5%) SARS-CoV-2 negative infants had a UTI or IBI. Of the 38 patients, 30 had a UTI, 7 had bacteremia without meningitis, and 3 had meningitis.

Notably, when breaking down rates of UTI or IBI in infants who tested positive for SARS-CoV-2 by age we see: 

  • 8-21 days: 2.4% (95%CI, 0.9-3.9%) 
  • 22-28 days: 3.0% (95%CI, 2.0-4.0%) 
  • 29-60 days: 0.5% (95%CI, 0.3-0.8%) 

There were 2,248 SARS-CoV-2 positive infants with normal IMs, and only 2 (<0.1%, 95%CI 0-0.2%) had IBI (both bacteremia without meningitis). 

I agree with the authors that there are some valuable take home points from this paper. First – full term, previously healthy, well appearing febrile infants aged 8-60 days with SARS-CoV-2 have significantly lower rates of UTI, bacteremia, and bacterial meningitis. Secondly, rates of UTI and IBI are exceptionally low in SARS-CoV-2 positive infants aged 29-60 days and in infants with normal IMs across all 3 AAP CPG age groups. Finally,the risk of invasive bacterial infection is not negligible in infants 28 days or younger even with SARS-CoV-2.

Prevalence of Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Infants Aged 8 to 60 Days With SARS-CoV-2. JAMA Netw Open. 2023 May 1;6(5):e2313354. doi: 10.1001/jamanetworkopen.2023.13354. 

What are your thoughts?