Section of Pediatric Emergency Medicine, Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
Division of Emergency Medicine, University of Minnesota, Masonic Children's Hospital, Minneapolis.
JAMA Netw Open. 2023 May 1;6(5):e2313354. doi: 10.1001/jamanetworkopen.2023.13354.
The prevalence of urinary tract infection (UTI), bacteremia, and bacterial meningitis in febrile infants with SARS-CoV-2 is largely unknown. Knowledge of the prevalence of these bacterial infections among febrile infants with SARS-CoV-2 can inform clinical decision-making.
To describe the prevalence of UTI, bacteremia, and bacterial meningitis among febrile infants aged 8 to 60 days with SARS-CoV-2 vs without SARS-CoV-2.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter cross-sectional study was conducted as part of a quality improvement initiative at 106 hospitals in the US and Canada. Participants included full-term, previously healthy, well-appearing infants aged 8 to 60 days without bronchiolitis and with a temperature of at least 38 °C who underwent SARS-CoV-2 testing in the emergency department or hospital between November 1, 2020, and October 31, 2022. Statistical analysis was performed from September 2022 to March 2023.
SARS-CoV-2 positivity and, for SARS-CoV-2-positive infants, the presence of normal vs abnormal inflammatory marker (IM) levels.
Outcomes were ascertained by medical record review and included the prevalence of UTI, bacteremia without meningitis, and bacterial meningitis. The proportion of infants who were SARS-CoV-2 positive vs negative was calculated for each infection type, and stratified by age group and normal vs abnormal IMs.
Among 14 402 febrile infants with SARS-CoV-2 testing, 8413 (58.4%) were aged 29 to 60 days; 8143 (56.5%) were male; and 3753 (26.1%) tested positive. Compared with infants who tested negative, a lower proportion of infants who tested positive for SARS-CoV-2 had UTI (0.8% [95% CI, 0.5%-1.1%]) vs 7.6% [95% CI, 7.1%-8.1%]), 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%]). Among infants aged 29 to 60 days who tested positive for SARS-CoV-2, 0.4% (95% CI, 0.2%-0.7%) had UTI, less than 0.1% (95% CI, 0%-0.2%) had bacteremia, and less than 0.1% (95% CI, 0%-0.1%) had meningitis. Among SARS-CoV-2-positive infants, a lower proportion of those with normal IMs had bacteremia and/or bacterial meningitis compared with those with abnormal IMs (<0.1% [0%-0.2%] vs 1.8% [0.6%-3.1%]).
The prevalence of UTI, bacteremia, and bacterial meningitis was lower for febrile infants who tested positive for SARS-CoV-2, particularly infants aged 29 to 60 days and those with normal IMs. These findings may help inform management of certain febrile infants who test positive for SARS-CoV-2.
SARS-CoV-2 感染的发热婴儿中尿路感染（UTI）、菌血症和细菌性脑膜炎的流行情况尚不清楚。了解 SARS-CoV-2 发热婴儿中这些细菌感染的流行情况，可以为临床决策提供信息。
描述 SARS-CoV-2 阳性与 SARS-CoV-2 阴性发热婴儿中，年龄为 8 至 60 天的发热婴儿中 UTI、菌血症和细菌性脑膜炎的患病率。
设计、地点和参与者：这是一项多中心横断面研究，作为美国和加拿大 106 家医院质量改进计划的一部分进行。参与者包括足月、既往健康、表现良好、年龄在 8 至 60 天、无细支气管炎且体温至少为 38°C 的婴儿，他们在 2020 年 11 月 1 日至 2022 年 10 月 31 日期间在急诊科或医院接受 SARS-CoV-2 检测。统计分析于 2022 年 9 月至 2023 年 3 月进行。
SARS-CoV-2 阳性，对于 SARS-CoV-2 阳性婴儿，正常与异常炎症标志物（IM）水平的存在。
通过病历回顾确定结果，包括 UTI、无脑膜炎的菌血症和细菌性脑膜炎的患病率。计算了每种感染类型中 SARS-CoV-2 阳性与阴性婴儿的比例，并按年龄组和正常与异常 IM 进行分层。
在 14402 名接受 SARS-CoV-2 检测的发热婴儿中，8413 名（58.4%）年龄为 29 至 60 天；8143 名（56.5%）为男性；3753 名（26.1%）检测呈阳性。与 SARS-CoV-2 检测阴性的婴儿相比，SARS-CoV-2 检测阳性的婴儿中 UTI 的比例较低（0.8% [95%CI，0.5%-1.1%] vs 7.6% [95%CI，7.1%-8.1%]），菌血症无脑膜炎（0.2% [95%CI，0.1%-0.3%] vs 2.1% [95%CI，1.8%-2.4%]）和细菌性脑膜炎（<0.1% [95%CI，0%-0.2%] vs 0.5% [95%CI，0.4%-0.6%]）。在 SARS-CoV-2 检测阳性且年龄为 29 至 60 天的婴儿中，0.4%（95%CI，0.2%-0.7%）患有 UTI，不到 0.1%（95%CI，0%-0.2%）患有菌血症，不到 0.1%（95%CI，0%-0.1%）患有脑膜炎。在 SARS-CoV-2 阳性婴儿中，与异常 IM 相比，正常 IM 的婴儿患有菌血症和/或细菌性脑膜炎的比例较低（<0.1% [0%-0.2%] vs 1.8% [0.6%-3.1%]）。
SARS-CoV-2 阳性发热婴儿中 UTI、菌血症和细菌性脑膜炎的患病率较低，尤其是年龄为 29 至 60 天的婴儿和正常 IM 的婴儿。这些发现可能有助于为某些 SARS-CoV-2 检测呈阳性的发热婴儿的管理提供信息。
