Do not Miss the Diagnosis of Bacterial Sepsis in Infants With COVID-19.

To the Editors:

A 34-day-old male infant presented with a 2-day-history of cough, poor feeding and vomiting after feeding. His severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction test was positive, and he was admitted to the hospital for intravenous hydration. Physical examination revealed no specific finding of coronavirus Disease 2019 (COVID-2019) or bacterial infections. His biochemical, hematological parameters and acute phase reactants at admission were in the normal reference range. On the 3rd day of admission, he developed tachycardia and became restless and inconsolable. His laboratory results revealed elevated C-reactive protein level [8.75 mg/dl–(0–0.5 mg/dl)]. Empirical antimicrobial treatment (ampicillin and cefotaxime) was initiated after sepsis workup was performed. Enterobacter cloaca was isolated from the 2 consecutive blood cultures.

COVID-19 seems to have a favorable clinical course in children; however, knowledge about the course of disease in symptomatic infants is scarce.[1] A study of pediatric SARS-CoV-2 cases in China reported that 11% of infants had a severe or critical illness.[2] In infants, findings such as fever, lethargy, poor feeding, vomiting, tachypnea and tachycardia attributed to the SARS-CoV-2[3] can be also seen in bacterial sepsis. Laboratory parameters may not always help distinguish between COVID-19 and bacterial sepsis. Bacterial coinfection has been previously reported in SARS-CoV-2-positive infants.[4] A preterm neonate was reported to develop sepsis caused by Enterobacter species as in our case.[5] It is important that clinicians be aware of the development of bacterial sepsis during SARS-CoV-2 infection, especially in infants.