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Application of low-risk criteria and approach for the febrile infant: A reasonable approach for treating febrile infants younger than 3 months who have a temperature of greater than 38°C.
Application of algorithms for children aged 3-36 months: A reasonable approach for treating infants and young children aged 3-36 months who have a temperature of at least 39.5°C.

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Age	Organism^*	Positive Blood Cultures, %
Neonates < 1 mo	Group B Streptococcus	73
	Escherichia coli	8
	S pneumoniae	3
	Staphylococcus aureus	3
	Enterococcus species	3
	Enterobacter cloacae	3
Infants aged 1-2 mo	Group B Streptococcus	31
	E coli	20
	Salmonella species	16
	S pneumoniae	10
	H influenzae type b	6
	S aureus	4
	E cloacae	4
^* Also, less frequently (< 1%), Listeria species, Klebsiella species, group A Streptococcus, Staphylococcus epidermis, Streptococcus viridans, and N meningitidis

Organism^*	1975-1993, %	1993, %	1993-1996, %	1990 to present, %
S pneumoniae	83-86	93	92	89
H influenzae type b	5-13	2	0	0
N meningitidis	1-3	…	…	…
Salmonella species	1-7	…	…	…
^* Also, less frequently (< 1%), E coli, S aureus, Streptococcus pyogenes, group B Streptococcus, Moraxella species, Kingella species, Yersinia species, and Enterobacter species

Age	Temperature, Degrees Celsius	Rate of Bacterial Infection, %
Neonates < 1 mo	38-38.9	5
	39-39.9	7.5
	≥ 40	18
Infants aged 1-2 mo	38-38.9	3
	39-39.9	5
	≥ 40	26

Temperature, Degrees Celsius	Occult Pneumococcal Bacteremia, %	Positive Blood Culture, %	Positive Blood Culture, %	Occult Pneumococcal Bacteremia, %
≤ 39	Very low	1.6	1	…
39-39.4	1.2	1.6	5	…
39.5-39.7	2.5	2.8	5	…
39.8-39.9	2.5	2.8	5	…
40-40.2	3.2	3.7	5	10-10.4
40.3-40.5	3.2	3.7	5	10-10.4
40.5-40.9	4.4	3.8	12	10-10.4
≥ 41	9.3	9.2	12	10-10.4

Study	Cutoff	NPV, %	PPV, %
Kuppermann, 1999^[1]	WBC >15	99	6
Lee, 2001^[35]	WBC >15	99	5
Strait, 1999^[46]	WBC >15	98	6

Study	Screening Goal	Cutoff, per HPF	NPV, %	PPV, %
Fernandez Lopez, 2003^[56]	Invasive bacterial infection^*	WBC >17	69	69
Pulliam, 2001^[57]	Serious bacterial infection^†	WBC >15	89	30
Lacour, 2001^[58]	Serious bacterial infection^‡	WBC >15	89	46
Isaacman, 2002^[59]	Occult bacterial infection^§	WBC >17	95	30
^* Culture-positive bacteremia/meningitis/sepsis/bone/joint infection; dimercaptosuccinic acid (DMSA)–positive pyelonephritis; lobar pneumonia; bacterial enteritis in infants younger than 3 months ^† Culture-positive bacteremia/meningitis/septic arthritis/urinary tract infection (UTI); focal infiltrate on chest radiograph ^‡ Culture-positive bacteremia/meningitis/osteomyelitis; DMSA-positive pyelonephritis; lobar pneumonia ^§ Culture-positive bacteremia/UTI; lobar pneumonia

ANC	Sensitivity, %	Specificity, %	PPV, %	NPV, %
10,000	76	78	8	99.2
>7,200	82	74	7.5	99.4

Illness Duration	Screening Goal	Optimal Cutoff	NPV, %	PPV, %
Any (< 12 h and >12 h)	Invasive bacterial infection^*	0.6	90	91
< 12 h	Invasive bacterial infection^*	0.7	90	97
*Culture-positive bacteremia/meningitis/sepsis/bone/joint infection; DMSA-positive pyelonephritis; lobar pneumonia; bacterial enteritis in infants younger than 3 months

Criterion	Philadelphia	Boston	Rochester	AAP 1993
Age	1-2 mo	1-2 mo	0-3 mo	1-3 mo
Temperature	38.2°C	≥38°C	≥38°C	≥38°C
Appearance	AIOS^*< 15	Well	Any	Well
History	Immune	No antibiotics in the last 24 h; No immunizations in the last 48 h	Previously healthy	Previously healthy
Examination	Nonfocal	Nonfocal	Nonfocal	Nonfocal
WBC count	< 15,000/μL; band-to-neutrophil ratio < 0.2	< 20,000/μL	5-15,000/μL; ABC < 1,000	5-15,000/μL; ABC < 1,000
Urine assessment	< 10 WBCs per HPF; Negative for bacteria	< 10 WBCs per HPF; Leukocyte esterase negative	< 10 WBCs per HPF	< 5 WBCs per HPF
CSF assessment	< 8 WBCs per HPF; Negative for bacteria	< 10 WBCs per HPF	< 10-20 WBCs per HPF	…
Chest radiography	No infiltrate	Within reference range, if obtained	Within reference range, if obtained	…
Stool culture	< 5 WBCs per HPF	…	< 5 WBCs per HPF	…
^* Acute illness observation score

Complication	No Antibiotic Therapy, %	Oral Antibiotic Therapy, %	Intramuscular/Intravenous Antibiotic Therapy, %
Persistent bacteremia	18-21	3.8-5	0-5
New focal infection	13	5-6.6	5-7.7
Meningitis	9-10	4.5-8.2	0.3-1

Complication	No Antibiotic Therapy, %	Any Antibiotic Therapy, %	Oral Antibiotic Therapy, %	Intramuscular/Intravenous Antibiotic Therapy, %
Persistent bacteremia	7-17	1-1.5	2.5	…
Focal infection/SBI	9.7-10	3.3-4	…	…
Meningitis	2.7-6	0.4-1	0.4-1.5	0.4-1

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