Several improvements have been made to the AAP clinical practice guideline “Clinical Practice Guideline: Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old” (Pediatrics 2021;148:e2021052228) since it was published online on Monday, July 19, 2021. The updated version was posted online on October 28, 2021. Most changes were to the formatting and typesetting for improved flow and presentation of the Key Action Statements. The new version improves the strong, evidence-based guideline.
Some updates merit mention and emphasis for the reader, as follows:
The algorithms are now also provided in full-page versions in separate Supplemental Information.
The words “Clinical Practice Guideline” have been added to the beginning of the official title of the article.
Under BACKGROUND, fourth paragraph, last sentence, the range “20% to 40%” was moved to appear after “along with modest specificities.”
In the section 1. Changing Bacteriology, first paragraph, the third sentence was changed to read “Recent studies reveal that Escherichia coli is now the most common organism to cause bacteremia, whereas GBS remains the most common cause of meningitis in most studies.”
In the legends of Figs 1–3, the values “>4000 to 5200” were changed to “>4000, >5200 mm3 (see text).” The intent was not to suggest a range but to acknowledge 2 different thresholds, derived differently and representing the current state of evidence.
In Fig 2, the final box in the last row, first line, should have read “Discontinue antimicrobial(s)(14a,b) and may…”
A reference to Table 3 reading “The antimicrobial agents in Table 3 are recommended for initial empirical therapy and should be modified after results of cultures and sensitivities” has been added after each INITIAL TREATMENT heading for emphasis.
In Table 1, KAS 14a was changed by adding to “Should discontinue antimicrobial agents… (3) there is no other infection requiring treatment (eg, otitis media).”
In the text box for KAS 2, Benefits, the range was corrected to “15% to 20% of infants.”
In the text under KAS 10, third paragraph, fifth sentence, the phrase “<90 days of age” was added after “5279 infants.”
In the text under KAS 10, eighth paragraph, third sentence, the phrase “for IBI” was added at the end of the sentence after the word “rule.”
In the text under KAS 12c, first paragraph, the first 2 sentences were deleted: “There are limited but emerging data on the risk for IBI in this age group. In a subset analysis from PECARN for infants 22 to 28 d old, 5 of 373 (1.3%) had IBI, whereas none of the 208 with markers for low risk had IBI (the 95% CI includes a prevalence of 2%).” At the end of the same paragraph in the text under KAS 12c, the following sentence was added: “However, because current prediction rules fail to detect ∼3% to 8% of bacteremia cases, antimicrobial agents may be administered.18,20”
In the text under KAS 7a, second paragraph, the fourth sentence should read: “Between 4% and 17.6% of pathogens take >24 hours to grow; less than 5% take >36 hours.” This change also has been made in the text boxes of KAS 14a, 14b, 21a, and 21c.
In the text under KAS 19d, first paragraph, the last sentence reading “However, in the literature, the committee could identify only 1 infant with a normal CSF analysis whose CSF grew a pathogen in the next 24 h” has been deleted.
Reference 145 was updated to the 2021 edition of the Red Book.
Several corrections were made to the Key References in the text boxes for the Key Action Statements.