A Meta-analysis of the Rates of Listeria monocytogenes and Enterococcus in Febrile Infants.

CONTEXT A change in the epidemiology of pathogens causing serious bacterial infection (SBI) has been noted since original recommendations were made for the empirical antibiotic choices for young infants with fever. OBJECTIVE To assess the prevalence of SBI caused by Listeria monocytogenes and Enterococcus species. DATA SOURCES A literature search was conducted on keywords related to SBI, L. monocytogenes, and Enterococcus spp. infections. STUDY SELECTION Eligible studies were those conducted in the United States and published between January 1998 and June 2014 focusing on SBI in infants≤90 days of age. DATA EXTRACTION The rates of urinary tract infection, bacteremia, and meningitis for each pathogen were recorded for each study. Meta-analysis was performed to calculate the prevalence for each pathogen in a random effects model with 0.5 continuity correction added to studies with zero events. RESULTS Sixteen studies were included. A total of 20,703 blood cultures were included, with weighted prevalences for L. monocytogenes and Enterococcus spp. bacteremia of 0.03% and 0.09%, respectively. A total of 13,775 cerebrospinal fluid cultures were included with event rates (unweighted prevalences) for L. monocytogenes and Enterococcus spp. meningitis of 0.02% and 0.03%, respectively. A total of 18,283 urine cultures were included, with no cases of L. monocytogenes and a weighted prevalence for Enterococcus spp. urinary tract infection of 0.28%. LIMITATIONS There may have been reporting bias or incomplete retrieval or inadvertent exclusion of relevant studies. CONCLUSIONS SBI caused by L. monocytogenes and Enterococcus spp. in febrile infants is rare, and therefore clinicians may consider a change in empirical antibiotic choices.