O0031: The Rate of SBI in Febrile Infants with Acute COVID-19 Infections

Background: Infants less than 60 days of age are at risk for serious bacterial infectious (SBIs), including urinary tract infection (UTI), bacteremia, and bacterial meningitis. Studies have shown that there is a lower risk of SBI for infants known to be infected with respiratory syncytial virus (RSV). It remains unclear whether the risk of SBI is altered in a meaningful way in the presence of acute COVID-19 infections. The objective of this study was to determine the risk of SBI in febrile infants with acute COVID-19 infection compared with those without acute COVID-19 infections.

Methods: We performed a retrospective chart review of febrile (≥38 oC) infants ≤60 days of age who presented to UPMC Children’s Hospital of Pittsburgh between November 2020 - February 2022. We excluded infants that were ill-appearing, born pre-term ( < 37 weeks), and with clinical bronchiolitis. We determined COVID-19 status using PCR testing of nasopharyngeal secretions. UTI, bacteremia, and bacterial meningitis were defined by the decision to complete appropriate treatment. SBI was defined as having at least one of the above-mentioned bacterial infections.

Results: Of 305 patients included, 90 infants (29.5%) were COVID-19 positive. The rate of SBI within our study population was 9.3% (28 of 302). The rate of SBIs in the COVID-19-positive infants was 2.2% (2 of 90) compared with 12.3% (26 of 212) in the COVID-19-negative infants (p=0.0002). The rate of UTI in the COVID-19-positive infants was 2.2% (2 of 90) compared with 10.8% (23 of 212) in the COVID-19-negative infants (p=0.001). No COVID-19-positive infants had bacteremia or bacterial meningitis; this did not achieve statistical significance.

Conclusion: We saw a significantly lower rate of both total SBI and UTI in febrile infants ≤60 days of age with confirmed COVID-19 infection. The rate of UTI remains appreciable, however. Based on this preliminary data, we plan on exploring this comparison in a larger patient population.