Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old

 KAS 1: Should obtain urine specimen by catheterization or suprapubic aspiration (SPA) of bladder for urinalysis and, if urinalysis result is positive, for culture.

 KAS 2: Should obtain a blood culture.

 KAS 3: May assess inflammatory markers (IMs).

 KAS 4: Should obtain CSF for analysis (WBC, protein, glucose, Gram stain) and culture for bacteria. See notes for viral testing.

 KAS 5: Should initiate parenteral antimicrobial therapy.

 KAS 6: Should actively monitor infants while awaiting results of bacterial cultures in a hospital setting with nurses and staff experienced in the care of neonates/young infants.

 KAS 7a: Should discontinue parenteral antimicrobial agents and discharge hospitalized patients when all of the following criteria are met: (1) culture results are negative for 24–36 h or only positive for contaminants; (2) the infant continues to appear clinically well or is improving (eg, fever, feeding); (3) tare no other reasons for hospitalization.

 KAS 7b: Should treat infants’ positive bacterial pathogens in urine, blood, or CSF with targeted antimicrobial therapy for the duration of time consistent with the nature of the disease, responsible organism, and response of the infant to treatment.

 KAS 8: Should obtain urine specimen by catheterization or SPA of bladder for urinalysis and, if urinalysis result is positive, for culture OR

 KAS 9: Should obtain a blood culture.

 KAS 10: Should assess IMs.

 KAS 11a: Clinicians may obtain a CSF analysis on infants 22–28 d of age even if all of the following criteria are met: (1) urinalysis result is negative or positive; (2) no IM obtained is abnormal; (3) blood and urine cultures have been obtained; (4) infant is hospitalized.

 11b. Should obtain CSF for analysis (WBC, protein, glucose, Gram stain), and bacterial culture if any IM obtained is positive.

 KAS 12a. Should administer parenteral antimicrobial therapy in a hospital if either of the following apply: (1) CSF analysis suggests bacterial meningitis; (2) urinalysis result is positive.

 KAS 12b. May administer parenteral antimicrobial therapy in a hospital if ALL of the following apply: (1) CSF analysis is normal; (2) urinalysis is normal; (3) Any IM obtained is abnormal.

 KAS 12c. May administer parenteral antimicrobial therapy to hospitalized infants even if ALL of the following are met: (1) urinalysis is normal; (2) no IM obtained is abnormal; (3) CSF analysis is normal or enterovirus-positive.

 KAS 12d: Should administer parenteral antimicrobial therapy for infants who will be managed at home even if ALL of the following are met: (1) urinalysis is normal; (2) No IM obtained is abnormal; (3) CSF analysis is normal.

 KAS 13a: May manage infants at home if all of the following criteria are met: (1) Urinalysis is normal; (2) No IM obtained is abnormal. (3) CSF analysis is normal or enterovirus-positive. (4) Verbal teaching and written instructions have been provided for monitoring throughout the period of time at home. (5) Follow-up plans for reevaluation in 24 h have been developed and are in place. (6) Plans have been developed and are in place in case of change in clinical status, including means of communication between family and providers and access to emergency medical care.

 KAS 13b: Should hospitalize infants in a facility with nurses and staff experienced in the care of neonates/young infants when CSF is not obtained or is uninterpretable.

 KAS 14a: Should discontinue antimicrobial agents and discharge hospitalized infants after 24 to 36 h of negative culture results if both of the following are met: (1) the infant is clinically well or improving (eg, fever, feeding); (2) there are no other reasons for hospitalization.

 KAS 14b: Should discontinue antimicrobial agents on infants managed at home when all of the following criteria are met: (1) infant is clinically well or improving (eg, fever, feeding) at time of reassessment; (2) all culture results are negative at 24–36 h; (3) there is no other infection requiring treatment (eg, otitis media).

 KAS 14c: Should treat infants’ positive bacterial pathogens in urine, blood, or CSF with targeted antimicrobial therapy for the duration of time consistent with the nature of the disease, responsible organism, and response of the infant to treatment.

 KAS 15: Should obtain urine specimen by bag, spontaneous void, or stimulated void for urinalysis and, if urinalysis result is positive, obtain a catheterization or SPA specimen for culture OR

 KAS 16: Should obtain a blood culture.

 KAS 17: Should assess IMs.

 KAS 18a: May obtain CSF for analysis (WBC, differential, protein, glucose, Gram stain), culture for bacteria, and test for enterovirus when CSF pleocytosis is detected or during enterovirus season if any IM is abnormal.

 KAS 18b: Need not obtain CSF for analysis and culture if all IMs obtained are normal.

 KAS 19a: Should use parenteral antimicrobial therapy if CSF analysis suggests bacterial meningitis.

 KAS 19b: May use parenteral antimicrobial therapy if both of the following apply: (1) CSF analysis (if CSF obtained) is normal; (2) any IM obtained is abnormal.

 KAS 19c: Should initiate oral antimicrobial therapy if all of the following apply: (1) CSF analysis (if CSF obtained) is normal; (2) urinalysis result is positive; (3) no IM obtained is abnormal.

 KAS 19d: Need not use antimicrobial therapy while awaiting bacterial culture results if all of the following are met: (1) CSF analysis, if obtained, or normal or enterovirus-positive; (2) urinalysis result is negative; (3) no IM obtained is abnormal.

 KAS 20a: Should hospitalize infants in a unit with nurses and staff experienced in the care of 29- to 60-d-old infants if CSF analysis, if obtained, is abnormal.

 KAS 20b: May hospitalize infants in a unit with nurses and staff experienced in the care of 29- to 60-d-old infants if any IM obtained is abnormal.

 KAS 20c: Should manage patients at home if all of the following criteria are met: (1) CSF analysis, if CSF obtained, is normal; (2) urinalysis result is negative; (3) all IMs obtained are normal; (4) appropriate parental education has been provided; (5) follow-up plans for reevaluation in 24 h have been developed and are in place (6) plans have been developed and are in place in case of change in clinical status, including means of communication between family and providers and access to emergency medical care.

 KAS 20d: May manage infants without antimicrobial treatment at home without having obtained interpretable CSF if all of the following are met: (1) urinalysis result is negative; (2) all IMs obtained are normal; (3) parents can return promptly if there is a change in infant condition and agree to follow-up in 24 to 36 h. Infants monitored at home should be reassessed in the following 24 h.

 KAS 20e: Need not treat with antimicrobial therapy if all of the following apply: (1) CSF analysis (if CSF obtained) is normal; (2) urinalysis result is negative; (3) no IM obtained is abnormal.

 KAS 21a. Should discontinue antimicrobial agents when all of the following are met: (1) all bacterial culture results are negative at 24–36 h; (2) infant is clinically well or improving (eg, fever, feeding); (3) there is no other infection requiring treatment (eg, otitis media).

 KAS 21b: Should discharge hospitalized patients with positive urine culture (UTI) results if all of the following are met: (1) blood culture result is negative; (2) result of CSF culture, if obtained, is negative; (3) infant is clinically well or improving (eg, fever, feeding); (4) there are no other reasons for hospitalization.

 KAS 21c: Should discontinue parenteral antibiotics (if started) and begin or continue oral antimicrobial for infants with UTIs managed at home when all of the following are met: (1) urine culture result is positive; (2) all other bacterial culture results are negative at 24–36 h; (3) infant is clinically well or improving (eg, fever, feeding).

 KAS 21d: Should treat infants’ positive bacterial pathogens in urine, blood, or CSF with targeted antimicrobial therapy for the duration of time consistent with the nature of the disease, responsible organism, and response of the infant to treatment.