Infectious Disease

Bacterial infections less common among infants with SARS-CoV-2

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Key takeaways:

  • UTIs, bacteremia and bacterial meningitis were less common among infants who tested positive for SARS-CoV-2.
  • Researchers said knowing the prevalence can inform decisions about care.

A study of more than 14,000 febrile infants found that UTIs, bacteremia and bacterial meningitis were less common among those who tested positive for SARS-CoV-2 than those who did not, according to findings published in JAMA Network Open.

A previous study by the same collaborative research found that the prevalence of bacterial infections in hospitalized infants had fallen to prepandemic levels after rising during the first year of COVID-19.

Data derived from Aronson PL, et al. JAMA Netw Open. 2023; doi:10.1001/jamanetworkopen.2023.13354.

According to the researchers, the prevalence of UTIs, bacteremia and bacterial meningitis among febrile infants aged 60 days or older being evaluated in the ED or hospital is as high as 10%, 3% and 1%, respectively. Instead, most of these patients have a viral infection like respiratory syncytial virus or influenza, the researchers reported, and bacterial infections are less prevalent in these patients.

Studies have shown that the prevalence of these bacterial infections may also be lower among infants who test positive for SARS-CoV-2, but the studies were small, conducted early in the pandemic, and did not always include febrile infants, according to Paul L Aronson, MD, MHS, professor of pediatric emergency medicine at Yale School of Medicine, and colleagues.

“Knowledge of the prevalence of [these infections] among febrile infants who test positive for SARS-CoV-2 can inform decision-making about invasive testing and disposition for these infants,” they wrote.

Aronson Healio told that the study was prompted by the “paucity” of data on the topic. Aronson and colleagues used a quality improvement project at their hospital network to “add to the literature.”

Paul L Aronson

“We felt that we had an opportunity to study over several thousand patients about the the prevalence of these more serious bacterial infections in infants,” Aronson said. “We hoped to be able to potentially inform clinicians about risks, so to speak, of these more serious bacterial infections when they have a febrile infant who is SARS-CoV-2 positive.”

For the study, they examined retrospective reports of full-term infants aged 8 to 60 days who were previously healthy and had received SARS-CoV-2 testing. The infants were seen at 106 hospitals in the United States and Canada between Nov. 1, 2020, and Oct. 31, 2022.

Of the 14,402 febrile infants included in the final analysis, 26.1% tested positive for SARS-CoV-2. Compared with infants who tested negative for the coronavirus, they had fewer UTIs, 0.8% (95% CI, 0.5%-1.1%) vs. 7.6% (95% CI, 7.1%-8.1%); and were less likely to have bacteremia without meningitis, 0.2% (95% CI, 0.1%-0.3%) vs. 2.1% (95% CI, 1.8%-2.4%), and bacterial meningitis, <0.1% (95 CI, 0%-0.2%) vs 0.5% (95% CI, 0.4%-0.6%).

“[I]t is possible that most infants aged 8 to 60 days who presented to the [ED] with fever found to be SARS-CoV-2 positive had active SARS-CoV-2 infection as the source of their fever. This would be in contrast to the potential asymptomatic viral shedding of other respiratory viruses, particularly rhinovirus,” the researchers wrote.

Because the study included frequent testing for a specific virus, it is possible that “the low prevalence of concomitant bacterial infection with SARS-CoV-2 would be generalizable if we tested for other respiratory viruses more frequently in febrile infants,” they wrote.

“This routine testing approach for other respiratory viruses may not improve the accuracy of risk stratification algorithms for febrile infants, although further study is needed.”

Aronson and colleagues noted that although the study was retrospective rather than prospective, the findings may help inform management of certain febrile infants who test positive for SARS-CoV-2.

“We hope that these results can help inform some decision-making and some of the discussions between clinicians and parents,” Aronson said.

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