Prevalence of Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Infants Aged 8 to 60 Days With SARS-CoV-2
Authors: Aronson Paul L. , Louie Jeffrey P. , Kerns Ellen , Jennings Brittany , Magee Sloane , Wang Marie E. , Gupta Nisha , Kovaleski Christopher , McDaniel Lauren M. , McDaniel Corrie E. ,   AAP REVISE II QI Collaborative, Agbim Chisom , Amadasun Owen , Beam Nicholas , Beamon Bradley D. , Becker Heather J. , Bedard Emma M. , Biondi Eric , Boulet Jenna , Bray-Aschenbrenner Amelia , Brooks Rona , Chen Clifford , Corboy Jacqueline B. , Dawlabani Nickolas , De Angulo Guillermo , Demie Senayit , Drexler Jennifer , Dudley Nanette , Ellis Andrew , Fath Kelsey , Frauenfelder Alejandra , Gill Jeff , Graf Thomas , Grageda Melissa , Greening Heidi , Griffin Alison M , Groen Amy , Guernsey III David T. , Gustafson Sarah , Hancock W Caleb , Iyer Sujit , Jaiyeola Patti Jo , Jayanth Aditi , Jennings Rebecca M. , Kachan-Liu Svetlana S. , Kamat Aditi , Kennedy Isaac J. , Khateeb Loay , Khilji Ohmed , Kleweno Elizabeth A. , Kumar Anika , Kwon Stephanie , La Alicia , Laeven-Sessions Petra , Le Kaitlyn Phuong , Leazer Rianna C. , Levasseur Kelly A. , Lewis Emilee C. , Maalouli Walid M. , Mackenzie Bonnie S. , Mahoney Kathleen E. , Margulis Deborah M. , Maskin Lauren , McCarty Emily , Monroy Alexa N. , Morrison John M. , Myszewski Jennifer H. , Nadeau Nicole L. , Nagappan Suresh , Newcomer Kristen , Nordstrom Matthew C. , Nguyen Diana , O'Day Peter , Oumarbaeva-Malone Yuliya , Parlin Ursula , Peters Summer , Piroutek Mary Jane , Quarrie Renee , Rice Kerrilynn , Romano Teresa M. , Rooholamini Sahar N. , Schroeder Cynthia L. , Segar Elizabeth K. , Seitzinger Patrick , Sharma Suparna , Simpson Blair E. , Singh Prachi , Sobeih Yasmine , Sojar Sakina , Srinivasan Karthik , Sterrett Emily C. , Swift-Taylor Mary Elizabeth , Szkola Sara , Thull-Freedman Jennifer , Topoz Irina , Vayngortin Tatyana , Veit Christopher , Ventura-Polanco Yenimar , Wallace Wu Ashley , Weiss Lindsay , Wong Erika K. , Zafar Sara 
Published: May 2023

Importance

The prevalence of urinary tract infection (UTI), bacteremia, and bacterial meningitis in febrile infants with SARS-CoV-2 is largely unknown. Knowledge of the prevalence of these bacterial infections among febrile infants with SARS-CoV-2 can inform clinical decision-making.

Objective

To describe 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.

Design, Setting, and Participants

This multicenter cross-sectional study was conducted as part of a quality improvement initiative at 106 hospitals in the US and Canada. Participants included 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. Statistical analysis was performed from September 2022 to March 2023.

Exposures

SARS-CoV-2 positivity and, for SARS-CoV-2–positive infants, the presence of normal vs abnormal inflammatory marker (IM) levels.

Main Outcomes and Measures

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.

Results

Among 14 402 febrile infants with SARS-CoV-2 testing, 9841 (68.3%) were aged 29 to 60 days; 8143 (56.5%) were male; and 3753 (26.1%) tested positive. Compared with infants who tested negative, a lower proportion of infants who tested positive for SARS-CoV-2 had UTI (0.8% [95% CI, 0.5%-1.1%]) vs 7.6% [95% CI, 7.1%-8.1%]), bacteremia without meningitis (0.2% [95% CI, 0.1%-0.3%] vs 2.1% [95% CI, 1.8%-2.4%]), and bacterial meningitis (&amp;lt;0.1% [95% CI, 0%-0.2%] vs 0.5% [95% CI, 0.4%-0.6%]). Among infants aged 29 to 60 days who tested positive for SARS-CoV-2, 0.4% (95% CI, 0.2%-0.7%) had UTI, less than 0.1% (95% CI, 0%-0.2%) had bacteremia, and less than 0.1% (95% CI, 0%-0.1%) had meningitis. Among SARS-CoV-2–positive infants, a lower proportion of those with normal IMs had bacteremia and/or bacterial meningitis compared with those with abnormal IMs (&amp;lt;0.1% [0%-0.2%] vs 1.8% [0.6%-3.1%]).

Conclusions and Relevance

The prevalence of UTI, bacteremia, and bacterial meningitis was lower for febrile infants who tested positive for SARS-CoV-2, particularly infants aged 29 to 60 days and those with normal IMs. These findings may help inform management of certain febrile infants who test positive for SARS-CoV-2.