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J Pediatr Infect Dis
DOI: 10.1055/s-0044-1795166
Original Article

Management of Febrile Infants Under 3 Months of Age with SARS-CoV-2 Infection in the Emergency Department

Patricia Diego
1   Pediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain
,
Aina Seguí
1   Pediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain
,
Victoria Trenchs 
1   Pediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain
2   Surgery and Surgical Specializations Department, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
3   Environment Effects on Child/Adolescent Well-Being, Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
,
Carles Luaces
1   Pediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain
2   Surgery and Surgical Specializations Department, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
3   Environment Effects on Child/Adolescent Well-Being, Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
,
Susanna Hernández-Bou
1   Pediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain
4   Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
› Author Affiliations Funding Not applicable.
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Abstract

Objective Febrile infants with a proven viral infection are at lower risk for a potentially serious bacterial infection (SBI). Our objective is to describe the management of young febrile infants with COVID-19 in the emergency department.

Methods Febrile infants <3 months with a positive PCR (polymerase chain reaction) test for SARS-CoV-2 between March 2020 and October 2022 were included in a cross-sectional study. The indication for complementary tests, hospital admission and antibiotic therapy was analyzed. We performed a global analysis and by age subgroups (<29 d and ≥29 d).

Results A total of 172 patients were included in the study, out of which 32 (18.6%) were <29 days old. Bacterial cultures were performed on 160 patients (93%), with urine cultures being the most frequently requested (151 patients; 87.8%). Overall, 39 infants (22.7%) were hospitalized, and 17 infants (9.9%) received antibiotics. In the subgroup analysis, patients <29 days had performed more frequently urine culture (100 vs. 85%; p = 0.015), blood culture (96.9 vs. 43.6%; p < 0.001), and cerebrospinal fluid culture (18.8 vs. 1.4%; p < 0.001). They also had a higher admission rate (68.8 vs. 12.1%; p < 0.001) and antibiotic prescription (21.9 vs. 7.1%; p = 0.02). SBI was identified in 10 patients (9 with urinary infections and 1 with bacteremia), while no invasive bacterial infection (IBI) was diagnosed in patients aged ≥29 days.

Conclusions The identification of SARS-CoV-2 led to less aggressive management in a significant number of cases compared with usual practice. The low prevalence of IBI would support its inclusion in the management algorithms for febrile infants, especially in patients aged ≥29 days. The nonnegligible prevalence of urinary infection would make it necessary to maintain its screening.

Keywords

fever without a source - febrile infant - SARS-CoV-2 - serious bacterial infection


Publication History

Received: 17 June 2024

Accepted: 02 November 2024

Article published online:
12 December 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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