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Bacterial coinfection in young febrile infants with SARS-CoV-2 infection

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Abstract

We aimed to assess the prevalence of serious bacterial infections (SBIs) in febrile infants < 90 days of age with SARS-CoV-2 infection versus SARS-CoV-2-negative febrile infants. A retrospective cohort study was conducted in a tertiary pediatric emergency department between March 2020 and October 2022. Febrile infants < 90 days of age who underwent SARS-CoV-2 testing were included. SBIs were defined as urinary tract infection (UTI), bacteremia, and/or bacterial meningitis; bacteremia and bacterial meningitis were considered invasive bacterial infections (IBIs). SBIs rates were compared between SARS-CoV-2-positive and negative infants and stratified by age. We included 779 infants: 221 (28.4%) SARS-CoV-2-positive and 558 (71.6%) SARS-CoV-2-negative. The SBI rate in the SARS-CoV-2-positive group was 5.9% vs 22.9% in the SARS-CoV-2-negative group (p < 0.001; relative risk (RR) 0.26; [95% CI 0.15–0.44]); the most common infections were UTI (5.4% vs 22.0%; p < 0.001). The IBI rate was 0.5% in the SARS-CoV-2–positive group vs. 3.2% in the negative group (p = 0.024; RR 0.14 [95% CI 0.02–1.04]). There were no cases of bacterial meningitis in the positive infants. SARS-CoV-2-positive infants > 28 days of age had a decreased likelihood of SBI (RR 0.22 [95% CI 0.11–0.43]), with no cases of IBI identified.

     Conclusions: Febrile infants < 90 days of age with SARS-CoV-2 infection are at significantly lower risk of SBIs than those who are SARS-CoV-2-negative. Nevertheless, the rate of UTI remains considerable in SARS-CoV-2-positive infants. SARS-CoV-2 detection may be relevant in considering IBI risk for well-appearing febrile infants 29–89 days of age.

What is Known:

• Febrile infants with laboratory-confirmed viral infections have a significantly lower risk of serious bacterial infections when compared to those without them. Data focusing on very young febrile infants with a SARS-CoV-2 infection is still limited.

What is New:

• Young febrile infants with SARS-CoV-2 infection are at significantly lower risk of serious bacterial infections than those who are SARS-CoV-2-negative. Nevertheless, the rate of urinary tract infection remains considerable. SARS-CoV-2 detection may be relevant in considering invasive bacterial infection risk for well-appearing febrile infants 29–89 days of age.

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Abbreviations

CSF:

Cerebrospinal fluid

CI:

Confidence interval

ED:

Emergency department

FWS:

Fever without source

IBIs:

Invasive bacterial infections

ICU:

Intensive care unit

IQR:

Interquartile range

PAT:

Pediatric Assessment Triangle

RR:

Relative risk

RT-PCR:

Real-time polymerase chain reaction

SBIs:

Serious bacterial infections

UC:

Urine cultures

UTI:

Urinary tract infection

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain

    Susanna Hernández-Bou, Victoria Trenchs, Patricia Diego, Aina Seguí & Carles Luaces

  2. Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain

    Susanna Hernández-Bou

  3. University of Barcelona, Barcelona, Spain

    Victoria Trenchs & Carles Luaces

  4. Environment Effects on Child/Adolescent Well-being, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain

    Victoria Trenchs & Carles Luaces

Authors
  1. Susanna Hernández-Bou
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  2. Victoria Trenchs
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  3. Patricia Diego
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  4. Aina Seguí
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  5. Carles Luaces
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Contributions

All authors contributed to the study conception and design. Material preparation and analysis were performed by Susanna Hernández-Bou and Victoria Trenchs. Data collection was performed by Patricia Diego and Aina Seguí. The first draft of the manuscript was written by Susanna Hernández-Bou and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Victoria Trenchs.

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Ethics approval

The Sant Joan de Déu Research Foundation Ethics Committee (PIC-110-22) approved this study.

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Since the data were extracted from a registry, the information contained in it was anonymous, and since no interventions were performed on patients, informed consent was not required or requested.

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Not applicable.

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The authors have no relevant financial or non-financial interests to disclose

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Communicated by Tobias Tenenbaum

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Hernández-Bou, S., Trenchs, V., Diego, P. et al. Bacterial coinfection in young febrile infants with SARS-CoV-2 infection. Eur J Pediatr 183, 281–288 (2024). https://doi.org/10.1007/s00431-023-05212-9

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