A single-center study in Canada found a low incidence of bacterial infections in infants with viral infections, including SARS-CoV-2, researchers reported today in JAMA Network Open.
The study, conducted at McGill University Hospital in Montreal, sought to assess the prevalence of urinary tract infections (UTIs), bacteremia, and bacterial meningitis among febrile infants ages 8 to 60 days who were systematically tested for SARS-CoV-2 and non–SARS-CoV-2 infections. Studies have suggested that the presence of a respiratory virus in infants is associated with a decreased risk of these infections, but it's unclear whether the emergence of SARS-CoV-2 has changed this risk, and questions remain about how viral testing should guide laboratory evaluation and management.
Around 12% had UTI, bacteremia, or bacterial meningitis
A total of 931 infants were included in the analysis (median age, 38 days; 58.8% male; 46% hospitalized). Viruses were detected in 611 infants (65.6%), including 163 (17.5%) with SARS-CoV-2. Overall, 107 infants (11.5%) had UTI, bacteremia, or bacterial meningitis, and 20 (2.2%) had invasive bacterial infections (IBIs; ie, bacteremia and bacterial meningitis collectively). The prevalence of UTI, bacteremia, and bacterial meningitis was lower among infants with non–SARS-CoV-2 viruses (7.8%) compared with those with no detectable virus (20.9%), and even lower in infants with SARS-CoV-2 (3.1%).
All five infections in infants with SARS-CoV-2 were culture-confirmed UTIs. There were significantly fewer IBIs in both SARS-CoV-2 (0 of 163 infants) and non–SARS-CoV-2 groups (5 of 448 infants [1.11%]) compared with virus-negative infants (15 of 320 infants [4.69%]). All five IBIs in infants with non–SARS-CoV-2 viruses were bacteremia.
A confirmed non–SARS-CoV-2 virus should not affect the initial evaluation for young infants with fever.
"These findings support AAP [American Academy of Pediatrics] recommendations that a confirmed non–SARS-CoV-2 virus should not affect the initial evaluation for young infants with fever," the study authors wrote. "However, findings demonstrating the very low risk of IBIs among infants with SARS-CoV-2 may assist clinicians individualize management and inform shared decision-making with parents, particularly when rapid COVID-19 testing results are known or available at the point of care."