Aim The aim of the study was to describe age‐ and sex‐specific prevalence of serious bacterial infections (SBI: urinary tract infection, bacteraemia, meningitis) among febrile infants ≤60 days in Sweden. Methods This is a retrospective study in 4 Pediatric Emergency Departments from 2014 to 2017, in previously healthy, full‐term infants ≤60 days with fever without a source. Results Of the 1,701 included infants, 214 (12.6%; 95% CI, 11.1–14.3) had an SBI. Urinary tract infection (UTI) was diagnosed in 196 (11.5%; 95% CI, 10.0–13.1) patients. In the ≤28 and 29–60 days age‐groups, meningitis prevalence was 0.9% (95% CI, 0.3–2.0) and 0.3% (95% CI, 0.1–0.8), whereas bacteraemia prevalence was 3.2% (95% CI, 1.9–4.9) and 0.6% (95% CI, 0.2–1.3). The SBI prevalence was higher in boys 16.0% (95% CI, 13.8–18.5) than girls 8.0% (95% CI, 6.2–10.2; p<0.001), due to 2‐fold higher UTI risk. The prevalence of meningitis in boys was 0.3% (95% CI, 0.1– 0.9) vs. 0.7% (95% CI, 0.2–1.6) in girls and of bacteraemia 1.8% (95% CI, 1.0–2.8) vs. 1.0% (95% CI, 0.4–2.0), respectively. Conclusions The total SBI prevalence was 12.6%, and UTI represented the vast majority. The prevalence of bacteraemia and meningitis was low, particularly in the 29–60 days age group, without significant difference between boys and girls.

Background: Management of febrile infants ≤60 days of age varies, and the age for routine investigations and antibiotic-treatment is debated. The American Academy of Pediatrics recommended age threshold for lumbar puncture (LP) is 21 days and for blood culture 60 days. We describe management and adverse outcome of febrile infants ≤60 days old, in Sweden. Methods: Retrospective cross-sectional study of infants ≤60 days of age with fever without source evaluated in 4 University pediatric emergency departments, between 2014 and 2017. Adverse outcome was defined as delayed-treated invasive bacterial infection (IBI: meningitis or bacteremia). Results: We included 1701 infants. In infants ≤21 days old, LP was performed in 16% (95% CI: 12–20) and blood culture in 43% (95% CI: 38–48). Meningitis was diagnosed in 5 (1.3%; 95% CI: 0.4–3.0) and bacteremia in 12 (4.5%; 95% CI: 2.6–7.0) infants. Broad-spectrum antibiotics were not administered to 66% (95% CI: 61–71), of which 2 (0.8%; 95% CI: 0.1–2.8) diagnosed with IBI (1 meningitis and 1 bacteremia). In the 29–60 days age group, blood culture was performed in 21% (95% CI: 19–24), and broad-spectrum antibiotics were not administered to 84% (95% CI: 82–86), with no case of delayed-treated bacteremia. Conclusions: The rates of LP, blood culture and broad-spectrum antibiotics were low. Despite that, there were few delayed-treated IBIs, but 2 of the 17 infants ≤21 days of age with IBI were not timely treated, which prompts the need for a safer approach for this age group. Also, the utility of routine blood culture for all febrile infants 29–60 days old could be questioned.

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Febrile infants have a relatively high risk of meningitis, bacteremia, and urinary tract infection (UTI), which are often defined as serious bacterial infections (SBIs). Studies have reported that the prevalence of SBIs was 9%-25% in febrile infants ≤60 days. [1][2][3][4][5][6] Because of this high risk, a number of guidelines have been developed to manage febrile infants. 4,7,8 Previous studies showed that almost 30% of infants brought to paediatric emergency departments (PEDs) due to fever were afebrile during their examination. 6,9,10 It has been suggested

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