From the Departments of Pediatric Hospital Medicine and Emergency Medicine, Nicklaus Children's Hospital, Miami, FL.
Pediatr Emerg Care. 2021 Apr 1;37(4):232-236. doi: 10.1097/PEC.0000000000002380.
The purposes of this study were to describe the clinical characteristics of febrile infants younger than 90 days with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, to investigate the prevalence of serious bacterial infections (SBIs) in these infants, and to compare the risk of SBI in SARS-CoV-2-positive febrile infants with sex- and age-matched SARS-CoV- 2-negative febrile infants.
This was a retrospective cohort study conducted from March to November 2020 in a tertiary children's hospital. Patients were identified by International Classification of Diseases, 10th Revision codes and included if age was younger than 90 days, a SARS-CoV-2 test was performed, and at least 1 bacterial culture was collected. Positive cases of SARS-CoV-2 were age- and sex-matched to negative controls for analysis. Serious bacterial infection was defined as a urinary tract infection, bacterial enteritis, bacteremia, and/or bacterial meningitis.
Fifty-three SARS-CoV-2-positive infants were identified with a higher rate of respiratory symptoms and lower white blood cell and C-reactive protein values than their SARS-CoV-2 matched controls. The rate of SBI in the SARS-CoV-2-positive infants was 8% compared with 34% in the controls; the most common infections were urinary tract infections (6% vs 23%). There were no cases of bacteremia or bacterial meningitis in the COVID-19 (coronavirus disease 2019) infants and 2 (4%) cases of bacteremia in the controls. The relative risk of any SBI between the 2 groups was 0.22 (95% confidence interval, 0.1-0.6; P ≤ 0.001).
These results suggest that febrile infants younger than 90 days with COVID-19 have lower rates of SBI than their matched SARS-CoV-2-negative controls. These data are consistent with previous studies describing lower risks of SBI in febrile infants with concomitant viral respiratory tract infections.
本研究旨在描述 90 日龄以下患有严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的发热婴儿的临床特征，探讨这些婴儿中严重细菌感染（SBI）的发生率，并比较 SARS-CoV-2 阳性发热婴儿与 SARS-CoV-2 阴性发热婴儿的 SBI 风险。
这是一项回顾性队列研究，于 2020 年 3 月至 11 月在一家三级儿童医院进行。通过国际疾病分类，第 10 版代码识别患者，纳入标准为年龄小于 90 天、进行 SARS-CoV-2 检测且至少采集 1 份细菌培养。SARS-CoV-2 阳性病例与 SARS-CoV-2 阴性对照病例进行年龄和性别匹配分析。严重细菌感染定义为尿路感染、细菌性肠炎、菌血症和/或细菌性脑膜炎。
共确定 53 例 SARS-CoV-2 阳性婴儿，其呼吸道症状发生率较高，白细胞和 C 反应蛋白值较低。SARS-CoV-2 阳性婴儿的 SBI 发生率为 8%，对照组为 34%；最常见的感染是尿路感染（6%比 23%）。COVID-19（2019 年冠状病毒病）婴儿中无菌血症或细菌性脑膜炎病例，对照组中有 2 例（4%）菌血症病例。两组间任何 SBI 的相对风险为 0.22（95%置信区间，0.1-0.6；P≤0.001）。
这些结果表明，COVID-19 发热婴儿的 SBI 发生率低于 SARS-CoV-2 阴性匹配对照婴儿。这些数据与先前描述伴有病毒呼吸道感染的发热婴儿 SBI 风险较低的研究结果一致。
