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Prevalence of invasive bacterial infection in febrile infants ≤90 days with a COVID-19 positive test: a systematic review and meta-analysis
  1. Silvia Pérez-Porra1,
  2. Elena Granda1,2,
  3. Helvia Benito3,4,
  4. Damian Roland5,6,
  5. Borja Gomez7,
  6. Roberto Velasco8,9
  1. 1Pediatrics Department, Hospital Universitario Rio Hortega, Valladolid, Spain
  2. 2Pediatrics Department, Hospital Universitario de Burgos, Burgos, Spain
  3. 3Gerencia de Atención Primaria de Segovia, Segovia, Spain
  4. 4CAP Concòrdia. Consorci Corporació Sanitària Parc Tauli, Sabadell, Barcelona, Spain
  5. 5SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
  6. 6Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
  7. 7Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario de Cruces. University of the Basque Country, UPV/EHU, Barakaldo, Bilbao, Basque Country, Spain
  8. 8Pediatric Emergency Unit, Department of Pediatrics, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
  9. 9Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
  1. Correspondence to Dr Elena Granda, Pediatrics Department, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain; e_granda15{at}hotmail.com

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.

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Data availability statement

Data are available upon reasonable request.

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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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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