How Covid-19 changed the epidemiology of febrile urinary tract infections in children in the emergency department during the first outbreak

Abstract

Background The first Covid-19 pandemic affected the epidemiology of several diseases. A general reduction in the emergency department (ED) accesses was observed during this period, both in adult and pediatric contexts. Methods This retrospective study was conducted on the behalf of the Italian Society of Pediatric Nephrology (SINePe) in 17 Italian pediatric EDs in March and April 2020, comparing them with data from the same periods in 2018 and 2019. The total number of pediatric (age 0–18 years) ED visits, the number of febrile urinary tract infection (UTI) diagnoses, and clinical and laboratory parameters were retrospectively collected. Results The total number of febrile UTI diagnoses was 339 (73 in 2020, 140 in 2019, and 126 in 2018). During the first Covid-19 pandemic, the total number of ED visits decreased by 75.1%, the total number of febrile UTI diagnoses by 45.1%, with an increase in the UTI diagnosis rate (+ 121.7%). The data collected revealed an increased rate of patients with two or more days of fever before admission ( p = 0.02), a significant increase in hospitalization rate (+ 17.5%, p = 0.008) and also in values of C reactive protein (CRP) ( p = 0.006). In 2020, intravenous antibiotics use was significantly higher than in 2018 and 2019 (+ 15%, p = 0.025). Urine cultures showed higher Pseudomonas aeruginosa and Enterococcus faecalis percentages and lower rates of Escherichia coli ( p = 0.02). Conclusions The first wave of the Covid-19 pandemic had an essential impact on managing febrile UTIs in the ED, causing an absolute reduction of cases referring to the ED but with higher clinical severity. Children with febrile UTI were more severely ill than the previous two years, probably due to delayed access caused by the fear of potential hospital-acquired Sars-Cov-2 infection. The possible increase in consequent kidney scarring in this population should be considered.

Pre- and Post-COVID-19 Appraisal of Antimicrobial Susceptibility for Urinary Tract Infections at an Outpatient Setting of a Tertiary Care Hospital in Delhi

“…Our results are in concordance with another study from a community setting [2]. However, according to other hospital-based studies, children requiring hospitalization due to UTI were not affected when compared to other diseases like respiratory tract infections, which are transmitted through the same route as SARS-CoV-2 [10]. Some studies evaluating the effect of the pandemic on UTI in community settings have shown decreased prevalence [15].…”

“…Antimicrobial resistance is a silent epidemic that got a boost during the pandemic. There are several studies evaluating the impact of the pandemic on UTI and antimicrobial resistance [9][10][11]. With increased awareness about antimicrobial stewardship, most hospitals are shifting to the rational use of antibiotics and updating their antibiogram periodically [12].…”

Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic

“…Several earlier investigations have noted either decreased or unchanged rates of UTI during the pandemic compared with prepandemic trends . However, these studies were limited to select settings of care (eg, outpatient only, inpatient pediatrics at only university-affiliated sites, US hospitals, and international hospitals).…”

“…Several earlier investigations have noted either decreased or unchanged rates of UTI during the pandemic compared with prepandemic trends. 16 , 18 , 19 , 20 , 21 , 22 However, these studies were limited to select settings of care (eg, outpatient only, 16 inpatient pediatrics at only university-affiliated sites, 18 , 19 US hospitals, 16 , 18 , 19 and international hospitals 20 , 21 , 22 ). Additionally, because these studies focused on numerous conditions, they did not use comprehensive lists of diagnosis codes, did not require evidence of antibiotic treatment for the definition of UTI, and did not examine severity measures.…”

“…While many investigations have described changes in patterns of medical care use and trends in common childhood diagnoses during the pandemic, 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 studies have not looked specifically at the incidence of UTI diagnoses in both ambulatory and inpatient settings across community and children’s hospitals. The aims of this study were to provide estimates of population-level UTI incidence and assess changes in UTI diagnoses and measures of UTI severity, such as hospitalizations and intensive care unit (ICU) admissions, during the COVID-19 pandemic.…”