null Fever is now more often a sign of serious bacterial infection

RI-MUHC researchers advocate for extra vigilance with feverish infants as new study shows startling numbers of serious bacterial infections during the pandemic

Montreal, July 15, 2021— A drop in ED visits and a spike in the proportion of serious bacterial infections (SBI) in newborns and young infants: these are the main findings of a new study conducted at the Montreal Children's Hospital of the McGill University Health Centre (MCH-MUHC) during the first year of the COVID-19 pandemic. Published in JAMA Network Open, the study shows that from March 2020 to March 2021, the number of visits to the MCH emergency department for febrile infants up to three months of age decreased by two-thirds, but the proportion of SBIs in this vulnerable group doubled, representing 20 per cent of cases. Furthermore, life-threatening invasive bacterial infections (IBIs) tripled in proportion during the same period. These findings highlight the importance of taking extra care with febrile neonates and young infants, as public health strategies for COVID-19 continue to be implemented.

A common reason for an emergency room visit, a fever with no obvious source in an infant under three months of age, is always of great concern. Young infants are vulnerable to infection because their immune systems are not sufficiently developed. They get most of their protection from maternal antibodies because they have low antibody production themselves. Even if the illnesses causing the fever are benign and resolve without treatment in the majority of cases, statistics from the past 30 years indicate that SBIs are usually detected in about 10 per cent of them.

“The spike in serious bacterial infections that we observed during the pandemic is concerning. With fewer viruses circulating because of public health measures, fever is now more often a sign of a serious bacterial infection,” says the principal investigator of the study, Dr. Brett Burstein, a pediatric emergency medicine physician and a junior scientist in the Child Health and Human Development Program at the RI-MUHC.

Dr. Brett Burstein is a pediatric emergency medicine physician and a junior scientist in the Child Health and Human Development Program at the Research Institute of the MUHC.
Dr. Brett Burstein is a pediatric emergency medicine physician and a junior scientist in the Child Health and Human Development Program at the Research Institute of the MUHC.

“About two per cent of all full-term babies are evaluated for fever in the first few months of life, and there exists significant ongoing variation in their management,” he explains. “These babies often have few other symptoms and doctors want to avoid unnecessary invasive tests, antibiotics and hospitalization.”

Using standardized clinical, laboratory, and follow-up data collected for all young infants presenting to the MCH emergency department with a rectal temperature of 38°C or higher, the authors of the study compared the proportions of SBIs and IBIs in all young infants during and before the pandemic. SBIs were defined as urinary tract infections, bacteremia, or bacterial meningitis; bacteremia and bacterial meningitis were considered IBIs.

“It is critical that physicians exercise caution and investigate appropriately, and that parents seek care for infants with fever, during the pandemic even more than before,” adds Dr. Burstein, who is also an assistant professor in the Department of Pediatrics at McGill University.

About the study

The study was conducted by Brett Burstein, Gregory Anderson and Alexandra Yannopoulos.

Burstein B, Anderson G, Yannopoulos A. Prevalence of Serious Bacterial Infections Among Febrile Infants 90 Days or Younger in a Canadian Urban Pediatric Emergency Department During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(7):e2116919. doi:10.1001/jamanetworkopen.2021.16919

About the RI-MUHC

The Research Institute of the McGill University Health Centre (RI-MUHC) is a world-renowned biomedical and healthcare research centre. The institute, which is affiliated with the Faculty of Medicine of McGill University, is the research arm of the McGill University Health Centre (MUHC) – an academic health centre located in Montreal, Canada, that has a mandate to focus on complex care within its community. The RI-MUHC supports over 450 researchers and around 1,200 research trainees devoted to a broad spectrum of fundamental, clinical and health outcomes research at the Glen and the Montreal General Hospital sites of the MUHC. Its research facilities offer a dynamic multidisciplinary environment that fosters collaboration and leverages discovery aimed at improving the health of individual patients across their lifespan. The RI-MUHC is supported in part by the Fonds de recherche du Québec – Santé (FRQS).

Media contact

Fabienne Landry
Communications coordinator, Research
McGill University Health Centre
Cell: 514 812-7722