Article Text
Abstract
Background Febrile infants with an infection by influenza or enterovirus are at low risk of invasive bacterial infection (IBI).
Objective To determine the prevalence of IBI among febrile infants ≤90 days old with a positive COVID-19 test.
Methods MEDLINE, Embase, Cochrane Central Register databases, Web of Science, ClinicalTrials.gov and grey literature were searched for articles published from February 2020 to May 2023. Inclusion criteria: researches reporting on infants ≤90 days of age with fever and a positive test for SARS-CoV-2 (antigen test/PCR). Case reports with <3 patients, articles written in a language other than English, French or Spanish, editorials and other narrative studies were excluded. Preferred Reposting Items for Systematic Reviews and Meta-analysis guidelines were followed, and the National Institutes of Health Quality Assessment Tool was used to assess study quality. The main outcome was the prevalence of IBI (a pathogen bacterium identified in blood and/or cerebrospinal fluid (CSF)). Forest plots of prevalence estimates were constructed for each study. Heterogeneity was assessed and data were pooled by meta-analysis using a random effects model. A fixed continuity correction of 0.01 was added when a study had zero events.
Results From the 1023 studies and 3 databases provided by the literature search, 33 were included in the meta-analysis, reporting 3943 febrile infants with a COVID-19 positive test and blood or CSF culture obtained. The pooled prevalence of IBI was 0.14% (95% CI, 0.02% to 0.27%). By age, the prevalence of IBI was 0.56% (95% CI, 0.0% to 1.27%) in those 0–21 days old, 0.53% (95% CI, 0.0% to 1.22%) in those 22–28 days old and 0.11% (95% CI, 0.0% to 0.24%) in those 29–60 days old.
Conclusion COVID-19-positive febrile infants ≤90 days old are at low risk of IBI, especially infants >28 days old, suggesting this subgroup of patients can be managed without blood tests.
PROSPERO registration number CRD42022356507.
- pediatric emergency medicine
- bacterial
- COVID-19
- infections
Data availability statement
Data are available upon reasonable request.
Statistics from Altmetric.com
Data availability statement
Data are available upon reasonable request.
Footnotes
BG and RV are joint senior authors.
SP-P and EG are joint first authors.
Handling editor Gene Yong-Kwang Ong
Twitter @sperezp95, @egranda15, @damian_roland, @BorjaGomez79, @RoberVelasco80
Presented at This study was presented in the PAS meeting 2023 in Washington DC (USA), in the SEUP annual meeting 2023 in Las Palmas de Gran Canarias (Spain) and in EuSEM annual meeting 2023 in Barcelona (Spain).
Contributors SP-P made substantial contribution to conception and design, collected the data and reviewed multiple manuscript drafts for important intellectual content. EG made substantial contribution to conception and design, collaborated in data collection, wrote the initial draft of the manuscript and reviewed multiple manuscript drafts for important intellectual content. HB made substantial contribution to conception and design, helped with methodological analysis and reviewed multiple manuscript drafts for important intellectual content. DR and BG made substantial contribution to conception and design, collaborated in data collection and reviewed multiple manuscript drafts for important intellectual content. RV conceptualised and designed the study, collaborated in data collection, analysed the data, reviewed multiple manuscript drafts for important intellectual content and acts as the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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