Febrile infants at low risk for serious bacterial infection - an appraisal of the Rochester criteria and implications for management

The Rochester criteria for the evaluation of infants with fever may accurately identify infants who are unlikely to have serious bacterial infections (SBI). The Rochester criteria, also called the low-risk criteria, relies upon physical examination, patient history, and laboratory test results. Researchers studied 1005 healthy-looking infants with fevers who were two months old or younger. Of these patients, 511 satisfied the low-risk criteria while 494 did not. Laboratory testing identified SBI in 1% of infants categorized as low-risk. Twelve percent of infants who were not categorized as low-risk were diagnosed with SBI. Almost 99% of infants identified as being at low-risk will not have SBI. Based upon these findings, infants with fever who are two months old or younger and fit the low-risk criteria should be managed by observation only.