62 - COVID-19 and Serious Bacterial Infection in Febrile Infants less than 60 days-old

Poster Number: 62
Publication Number: 62.105

David T. Guernsey, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Matthew Pfeffer, Maimonides Medical Center, Brooklyn, NY, United States; James Kimpo, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Hector Vazquez, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Jessica Zerzan, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States

Background: The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lead to the coronavirus disease 2019 (COVID-19) that drastically impacted the United States. Maimonides Medical Center located in Brooklyn, NY with the only children’s hospital in the largest borough of the largest city in the United States, at one point, was one of the epicenters of the COVID-19 pandemic. There was unclear evidence on how SARS-CoV-2 infection impacted children given the high prevalence of SAR-CoV-2 infection. Febrile infants less than 60 days-old are an ongoing challenge to risk-stratify for serious bacterial infection (SBI), including urinary tract infection, bacteremia, and meningitis.

Objective: Our objective was to assess the incidence of SBI in COVID-19 positive and COVID-19 negative patients. We hypothesized there would be a lower rate of SBI in SARS-CoV-2 positive febrile infants compared to those SARS-CoV-2 negative.

Design/Methods: This is a retrospective cohort study with a nested age-matched case-control study performed from March 2020 to June 2021. Infants less than 60 days-old presenting with fever were assigned groups based on SAR-CoV-2 infection. Blood, urine, and cerebrospinal fluid cultures were used as gold-standard to diagnose SBI. Overall rate of SBI as well as individual rates of SBI were compared between each group. We performed a subgroup-analysis evaluating the age group 29 to 60 days-old.

Results: A total of 164 subjects met criteria for analysis, 30 COVID-19 positive and 134 COVID-19 negative subjects. Rate of SBI was 14.9% (95% CI: 9.9-21.9%) in the COVID-19 negative group compared to 0% (95% CI: 0.0%-11.1%) in the COVID-19 group which demonstrated statistical significance, which the statistical significance maintained only for UTI. In the age-matched data, we found statistical significance for any SBI, and during individual SBI, the statistical significance was maintained for UTI and bacteremia. The 29 to 60 days-old subgroup-analysis did not achieve statistical significance.Conclusion(s): This study demonstrated the utility of including SARS-CoV-2 infection in part of the risk stratification of febrile infants less than 60 days-old. While overall there is low incidence of bacteremia and meningitis in this age-group, these results can contribute to existing literature that can potentially help decrease invasive testing and exposure to broad-spectrum antibiotics.