Hernández-Bou Susanna, Trenchs Victoria, Diego Patricia, Seguí Aina, Luaces Carles
Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain.
Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain.
Eur J Pediatr. 2024 Jan;183(1):281-288. doi: 10.1007/s00431-023-05212-9. Epub 2023 Oct 23.
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.
我们旨在评估90日龄以下感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的发热婴儿与未感染SARS-CoV-2的发热婴儿中严重细菌感染（SBI）的患病率。2020年3月至2022年10月期间，在一家三级儿科急诊科进行了一项回顾性队列研究。纳入了接受SARS-CoV-2检测的90日龄以下发热婴儿。SBI被定义为尿路感染（UTI）、菌血症和/或细菌性脑膜炎；菌血症和细菌性脑膜炎被视为侵袭性细菌感染（IBI）。比较了SARS-CoV-2阳性和阴性婴儿的SBI发生率，并按年龄分层。我们纳入了779名婴儿：221名（28.4%）SARS-CoV-2阳性和558名（71.6%）SARS-CoV-2阴性。SARS-CoV-2阳性组的SBI发生率为5.9%，而SARS-CoV-2阴性组为22.9%（p<0.001；相对风险（RR）0.26；[95%置信区间0.15 - 0.44]）；最常见的感染是UTI（5.4%对22.0%；p<0.001）。SARS-CoV-2阳性组的IBI发生率为0.5%，阴性组为3.2%（p = 0.024；RR 0.14 [95%置信区间0.02 - 1.04]）。阳性婴儿中没有细菌性脑膜炎病例。28日龄以上的SARS-CoV-2阳性婴儿发生SBI的可能性降低（RR 0.22 [95%置信区间0.11 - 0.43]），未发现IBI病例。结论：90日龄以下感染SARS-CoV-2的发热婴儿发生SBI的风险明显低于未感染SARS-CoV-2的婴儿。然而，SARS-CoV-2阳性婴儿的UTI发生率仍然相当高。对于29 - 89日龄外观良好的发热婴儿，检测SARS-CoV-2可能与考虑IBI风险有关。已知信息：•与未感染实验室确诊病毒感染的发热婴儿相比，感染实验室确诊病毒感染的发热婴儿发生严重细菌感染的风险显著降低。针对感染SARS-CoV-2的非常小的发热婴儿的数据仍然有限。新发现：•感染SARS-CoV-2的年轻发热婴儿发生严重细菌感染的风险明显低于未感染SARS-CoV-2的婴儿。然而，尿路感染的发生率仍然相当高。对于29 - 89日龄外观良好的发热婴儿，检测SARS-CoV-2可能与考虑侵袭性细菌感染风险有关。
