Modern risk-stratification strategies have been derived to identify infants at low risk of serious bacterial infections (SBIs; urinary tract infections, bacteremia, and bacterial meningitis) and invasive bacterial infections (IBIs; bacteremia and bacterial meningitis).1–3  These incorporate different diagnostic tests and low-risk cut-points. Procalcitonin testing offers the best discrimination of low-risk infants; however, this test is not universally available.5,6  Recent guidelines from the American Academy of Pediatrics (AAP) recommend that if procalcitonin is unavailable, C-reactive protein (CRP), absolute neutrophil count (ANC), and temperature should be used; however, these inflammatory markers have never been evaluated together in combination. This study sought to estimate the diagnostic accuracy of CRP, ANC, and temperature at AAP-recommended cut-points, prioritizing not missing IBIs.

This was a secondary analysis of quality improvement data collected prospectively to standardize diagnostic testing for febrile infants ≤60 days of age at an urban...

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