Infant UTI and IBI prevalence decreased during COVID-19 pandemic

Urinary tract infection (UTI) and invasive bacterial infection (IBI) prevalence lessened in infants during the COVID-19 pandemic, according to a recent study.

Annually, about 200,000 infants aged under 60 days showing signs of fever are analyzed in United States emergency departments (EDs). On average, 7% to 10% of these infants present with UTI, and 2% with IBI. Age effects IBI prevalence, with infants aged under 21 days having an IBI rate of 4% and infants aged 29 to 60 days having an IBI rate of 2%.

After the start of the COVID-19 pandemic in March 2020, the transmission of respiratory infections decreased, leading to a lower number of febrile infants being evaluated in EDs. This cause a greater proportion of UTI and IBI to be observed in infants for the following year.

Studies observing higher UTI and IBI rates were conducted at a single health system, and none took place beyond March 2021. Therefore, knowledge on UTU and IBI prevalence across the pandemic is necessary for accurate decisions to be made on hospitalizations and other treatment factors.

To evaluate UTI and IBI prevalence in infants aged 8 to 60 days throughout the pandemic, investigators conducted a multicenter cross-sectional study. The study period took place from November 1, 2020, to March 31, 2022, across 97 hospitals.

Participants included full-term infants aged 8 to 60 days with an observed temperature of over 38 degrees Celsius in the previous 24 hours, who were previously healthy and well-appearing. Infants present with bronchitis, specific bacterial infections, receipt of antibiotics or immunizations in the previous 48 hours, or those ill-appearing were excluded.

Data included demographic information, along with urine, blood, and cerebrospinal fluid (CSF) results. COVID-19 testing results were also included, and if an infant had a return visit within 7 days, they were tested for UTI and IBI.

UTI and IBI prevalence was the primary outcome, examined in the overall study population and in separate age groups. Changes in the prevalence of UTI, overall IBI, and bacteremia both with and without meningitis were the secondary outcomes. Presence of a positive urinalysis determined UTI, while a priori defined pathogen growth in the blood or CSF determined IBI.

Of the 9112 infants included in the study, 18% were aged 8 to 21 days, 12% were aged 22 to 28 days, and 70% were aged 39 to 60 days. All US census regions were included in the sample, and 5% of infants were born in Canada. Freestanding children’s hospitals evaluated 61% of infants, operationally dependent hospitals evaluated 29%, and general hospitals evaluated 10%.

UTI was seen in 603 infants, bacteremia without meningitis in 163, and bacterial meningitis in 43. As age increased, prevalence of every infection type decreased. A 14.9% infection rate was seen in infants aged 8 to 21 days, which decreased to 11.2% in infants aged 22 to 28 days, and 5.6% in infants aged 29 to 60 days.

Chances of all infection types decreased each month from November 2020 to March 2022. The UTI infection rate was 11.2% in November 2020, which was the highest infection rate during the study period. This reached a low of 3% in January 2022.

Bacteremia without meningitis reached its highest rate of 4.5% in November 2020, and its lowest rate of 0.3% in August 2021. Bacteremia meningitis reached its highest rate of 1.7% in February 2021, and its lowest rate of 0% in March 2022. IBI reached its highestrate of 6.1% in February 2021, and its lowest rate of 0.4% in January 2022.

The UTI rate was 4.1% in March 2022, while the IBI rate was 1.4%. This showed an overall decrease in UTI and IBI prevalence during the COVID-19 pandemic.

Reference

Aronson PL, Kerns E, Jennings B, Magee S, Wang ME, McDaniel CE, et al. Trends in prevalence of bacterial infections in febrile infants during the COVID-19 pandemic. Pediatrics. 2022;150(6). doi:10.1542/peds.2022-059235