title: Febrile infants at low risk for serious bacterial infection--an appraisal of the Rochester criteria and implications for management. Febrile Infant Collaborative Study Group.
abstract: OBJECTIVE
  Prospective studies were conducted to test the hypothesis that infants unlikely to have serious bacterial infections (SBI) can be accurately identified by low risk criteria.
  
  
  METHODS
  Febrile infants (rectal T > or = 38 degrees C) < or = 60 days of age were considered at low risk for SBI if they met the following criteria: 1) appear well; 2) were previously healthy; 3) have no focal infection; 4) have WBC count 5.0-15.0 x 10(9) cells/L (5000-15,000/mm3), band form count < or = 1.5 x 10(9) cells/L (< or = 1500/mm3), < or = 10 WBC per high power field on microscopic examination of spun urine sediment, and < or = 5 WBC per high power field on microscopic examination of a stool smear (if diarrhea). The recommended evaluation included the culture of specimens of blood, cerebrospinal fluid, and urine for bacteria. Outcomes were determined. The negative predictive values of the low risk criteria for SBI and bacteremia were calculated.
  
  
  RESULTS
  Of 1057 eligible infants, 931 were well appearing, and, of these, 437 met the remaining low risk criteria. Five low risk infants had SBI including two infants with bacteremia. The negative predictive value of the low risk criteria was 98.9% (95% confidence interval, 97.2% to 99.6%) for SBI, and 99.5% (95% confidence interval, 98.2% to 99.9%) for bacteremia.
  
  
  CONCLUSIONS
  These data confirm the ability of the low risk criteria to identify infants unlikely to have SBI. Infants who meet the low risk criteria can be carefully observed without administering antimicrobial agents.
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, NY 14642.
authors.forename: J A
authors.initials: JA
authors.lastname: Jaskiewicz
authors.forename: C A
authors.initials: CA
authors.lastname: McCarthy
authors.forename: A C
authors.initials: AC
authors.lastname: Richardson
authors.forename: K C
authors.initials: KC
authors.lastname: White
authors.forename: D J
authors.initials: DJ
authors.lastname: Fisher
authors.forename: R
authors.initials: R
authors.lastname: Dagan
authors.forename: K R
authors.initials: KR
authors.lastname: Powell
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005335:Fever of Unknown Origin / Q000453:epidemiology / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D000900:Anti-Bacterial Agents