The prevalence of bacteraemia and bacterial meningitis (commonly referred to as invasive bacterial infections or IBIs) among febrile infants informs ED clinician management decisions about the need for testing, treatment or hospitalisation. Using increasingly sophisticated risk stratification technologies, the management of these infants has evolved over time. Concurrently, the prevalence of IBI has decreased, largely due to vaccination and maternal antibiotic prophylaxis. The role of viral testing in medical decision-making for febrile infants is not clearly established. Prior work has suggested that febrile infants with viral infections may be at a lower risk of IBI; however, these studies are from a time when respiratory viral testing was inconsistently performed.1 The American Academy of Pediatrics’ clinical practice guideline does not state an explicit role for viral testing, leaving this an open question in need of further research.1 As the COVID-19 pandemic has resulted in increases in viral testing, researchers have greater opportunities to investigate how virus positivity impacts the risk of IBI in febrile infants.

In their meta-analysis published in EMJ,2 Pérez-Porra and colleagues describe the prevalence of IBI among febrile infants in the ED who were positive for COVID-19 infection using data from 33 prospective studies, retrospective studies and case series. The investigators identified an …