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TOPLINE:

In the third month of life, infants with fever who appeared well had a prevalence of invasive bacterial infection of 1.11%, with bacteremia accounting for most cases at 1% and bacterial meningitis occurring rarely at 0.1%.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis using data from prospective and retrospective studies to estimate the prevalence of invasive bacterial infection in well-appearing infants with fever who were aged 60-90 days.
• The analysis included 34,835 previously healthy, well-appearing, term-born infants evaluated for fever in emergency departments or outpatient settings across 20 cohorts from 59 studies.
• The primary outcome was the prevalence of invasive bacterial infection, defined as a composite of bacteremia and/or bacterial meningitis.

TAKEAWAY:

• The pooled prevalence of invasive bacterial infection in infants with fever in the third month of life was 1.11% (95% CI, 0.84%-1.47%; I² = 76.9%).
• Bacteremia accounted for the majority of invasive bacterial infection cases, with a pooled prevalence of 1.01% (95% CI, 0.76%-1.34%; I² = 75.8%).
• Bacterial meningitis was rare, with a pooled prevalence of 0.11% (95% CI, 0.08%-0.16%; I² = 5.8%).

IN PRACTICE:

“These data provide the most precise contemporary risk estimates and a foundation for management decisions for infants in the third month of life. Nevertheless, this pretest probability resides in a risk range where practice depends on shared parent and clinician risk tolerance for missed infection vs harms of overtesting,” the authors wrote.

SOURCE:

The study was led by Zachary Dionisopoulos, MDCM, of the Institute of Health Policy Management and Evaluation at the University of Toronto in Toronto, Ontario, Canada. It was published online on May 26, 2026, in JAMA Pediatrics.

LIMITATIONS:

Most studies were conducted in emergency departments, which may limit generalizability to other outpatient settings. Inclusion of retrospective cohorts may have introduced selection bias because they did not include infants who were not tested. The study did not assess the prevalence of urinary tract infections in this age group.

DISCLOSURES:

No specific funding was obtained for this study. One author disclosed receiving a career award from the Quebec Health Research Fund (FRQ-S) and a grant and reagent/material support from BioMerieux Canada and speaker honoraria from Thermo Fisher Scientific outside the submitted work. Another author disclosed receiving a training award from the FRQ-S, and a third author disclosed receiving an Investigator Grant Award Program salary award from the BC Children’s Hospital Research Institute.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.