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Fever in 2- to 6-Month-Old Infants

Fever in infants older than 2 months can be associated with serious bacterial infections, particularly UTIs.

Although the pneumococcal and Haemophilus influenzae type B conjugate vaccines have reduced risk for serious bacterial infection in infants, they have changed the landscape of fever management, especially in infants older than 2 months. Investigators at one institution in Connecticut prospectively evaluated 429 consecutive febrile infants (age, 57–180 days) who presented to the emergency department. Evaluation included routine blood and urine laboratory tests and diagnostic tests for viral infection.

Forty-four infants (10.3%) had test results consistent with serious bacterial infections (40 had urinary tract infections, 3 had bacteremia, 1 had both). None of the 58 infants who underwent lumbar puncture had bacterial meningitis. The 163 infants with viral infections were significantly less likely to have serious bacterial infections than the 251 infants without viral infections (4.9% vs. 13.5%). The incidence of urinary tract infections was identical in males and females (9.7%). Among males with known circumcision status, 36% (of 50) uncircumcised infants had UTIs compared with 1.6% (of 128) circumcised infants.

Comment: The 10% incidence of serious bacterial infection in infants older than 2 months is surprisingly high, but considering that their parents had either sought care in or were referred to the ED, the infants in this study likely were sicker than those seen in practice. Clinicians should be aware of the risk for serious bacterial infections, particularly UTIs, in infants who are 2 to 6 months old.

— Howard Bauchner, MD

Published in Journal Watch General Medicine May 16, 2006

Citation(s):

Hsiao AL et al. Incidence and predictors of serious bacterial infections among 57- to 180-day-old infants. Pediatrics 2006 May; 117:1695-701.

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