Department of Women's and Children' Health, Pediatric Infectious Disease Unit, Padua University, Padua, Italy.
Department of Women's and Children' Health, Pediatric Emergency Department, Padua University, Padua, Italy.
Ital J Pediatr. 2024 Aug 15;50(1):148. doi: 10.1186/s13052-024-01721-x.
Fever in children represents one of the most common causes of medical evaluation. Infants younger than 90 days of age are at higher risk of severe and invasive bacterial infections (SBI and IBI). However, clinical signs and symptoms of viral and bacterial infections in young infants are frequently similar, and several studies have shown that the risk of SBIs remains non-negligible even in the presence of a positive point-of-care viral test. Our study aims to evaluate whether the proportion of SBIs and IBIs in febrile infants younger than 90 days during the COVID-19 pandemic was higher than that in the pre-pandemic period, and to describe the proportion of SBIs and IBIs in infants with and without SARS-CoV-2 infection.
This was a retrospective single-center cohort study conducted at the Children's Hospital of the University of Padua in Italy, involving febrile young infants evaluated in the Pediatric Emergency Department (PED) and admitted to Pediatric Acute Care Unit (PACU) between March 2017 to December 2022. Infants admitted before the COVID-19 pandemic were compared to infants admitted during the pandemic period and SARS-CoV-2 positive patients to the negative ones.
442 febrile infants younger than 90 days were evaluated in Padua PED and admitted to the wards. The proportion of SBIs and IBIS did not significantly change over the study periods, ranging between 10.8% and 32.6% (p = 0.117) and between 0% and 7.6%, respectively (p = 0.367). The proportion of infants with a diagnosis of SBIs and IBIs was higher in the SARS-CoV-2 negative group (30.3% and 8.2%, respectively) compared to the positive group (8.5% and 2.8%, respectively) (p < 0.0001). The most common diagnosis in both groups was UTI, mainly caused by E. coli. A similar proportion of blood and urine cultures were performed, whereas lumbar puncture was more frequently performed in SARS-CoV-2 negative infants (40.2% vs 16.9%, p = 0.001).
Although the risk of concomitant serious bacterial infection with SARS-CoV-2 is low, it remains non-negligible. Therefore, even in SARS-CoV-2-positive febrile infants, we suggest that the approach to screening for SBIs remains cautious.
儿童发热是医学评估中最常见的原因之一。90 天以下的婴儿患严重和侵袭性细菌感染（SBI 和 IBI）的风险更高。然而，婴幼儿病毒和细菌感染的临床体征和症状常常相似，几项研究表明，即使进行了即时病毒检测呈阳性，SBI 的风险仍然不容忽视。我们的研究旨在评估 COVID-19 大流行期间 90 天以下发热婴儿的 SBI 和 IBI 比例是否高于大流行前，以及描述 SARS-CoV-2 感染和未感染婴儿的 SBI 和 IBI 比例。
这是一项在意大利帕多瓦大学儿童医院进行的回顾性单中心队列研究，涉及 2017 年 3 月至 2022 年 12 月期间在儿科急诊室（PED）评估并收入儿科急性护理病房（PACU）的发热小婴儿。将大流行前入院的婴儿与大流行期间入院的婴儿以及 SARS-CoV-2 阳性患者与阴性患者进行比较。
在帕多瓦 PED 评估了 442 名 90 天以下发热婴儿，并收入病房。SBI 和 IBI 的比例在研究期间没有显著变化，范围在 10.8%至 32.6%（p=0.117）和 0%至 7.6%之间（p=0.367）。SARS-CoV-2 阴性组（分别为 30.3%和 8.2%）诊断为 SBI 和 IBI 的婴儿比例高于阳性组（分别为 8.5%和 2.8%）（p<0.0001）。两组中最常见的诊断均为尿路感染，主要由大肠杆菌引起。两组均进行了相似比例的血和尿培养，而 SARS-CoV-2 阴性婴儿更常进行腰椎穿刺（40.2%对 16.9%，p=0.001）。
尽管 SARS-CoV-2 合并严重细菌感染的风险较低，但仍不容忽视。因此，即使在 SARS-CoV-2 阳性发热婴儿中，我们建议对 SBI 的筛查仍应谨慎。
