COVID-positive infants at lower risk of UTI, bacteremia and bacterial meningitis compared to COVID-19 negative febrile infants

U.S.A: Febrile infants aged 8 to 60 days who tested positive for COVID-19 had a lower prevalence of urinary tract infection (UTI), bacteremia, and bacterial meningitis. The prevalence of UTI and invasive bacterial infection was particularly low in infants aged 29 to 60 days and having normal inflammatory marker (IM) levels. The study results were published in the journal JAMA Network Open.  

Most of the febrile infants aged 60 days or younger who visit the emergency room have viral infections mainly due to upper respiratory tract infections. Those who have tested positive for respiratory viral infections generally have a lower prevalence of urinary tract infection (UTI), bacteremia, and bacterial meningitis. But there is uncertainty on the prevalence of urinary tract infection (UTI), bacteremia, and bacterial meningitis in febrile infants with SARS-CoV-2. As it helps in clinical decision-making, researchers conducted a multicenter cross-sectional study to assess 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. 

The study was carried out as part of a quality improvement initiative at 106 hospitals in the US and Canada. 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, were included in the study. SARS-CoV-2–positive infants were tested for the presence of normal vs abnormal inflammatory marker (IM) levels. The main 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. 95% CIs was calculated for each infection type and results were stratified by SARS CoV-2 positivity and AAP CPG age group. 

Key findings: 

• 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.
• COVID-positive infants had a lower proportion of UTI, bacteremia without meningitis, and bacterial meningitis when compared with infants who tested negative. 
• Among infants aged 29 to 60 days who tested positive for SARS-CoV-2, 0.4% had UTI, less than 0.1% had bacteremia, and less than 0.1% had meningitis.
• Among SARS-CoV-2-positive newborns, those with normal IMs had a lower proportion of bacteremia and/or bacterial meningitis than those with abnormal IMs.

Thus, a lower prevalence of UTI, bacteremia, and bacterial meningitis was found in febrile infants who tested positive for SARS-CoV-2, particularly infants aged 29 to 60 days and those with normal IMs.

Further reading: Aronson PL, Louie JP, Kerns E, et al. Prevalence of Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Infants Aged 8 to 60 Days With SARS-CoV-2. JAMA Netw Open. 2023;6(5):e2313354. doi: 10.1001/jamanetworkopen.2023.13354