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We carried out a prospective registry-based cohort study at the emergency department of 363 previously healthy well-appearing infants 3–24 months of age with fever without a source ≥40.5°C based on local protocol. Four were diagnosed with occult bacteremia (1.1%; 95% confidence interval: 0–2.2). Recommendations for nontesting for occult bacteremia screening in these children may have to be reconsidered when fever ≥40.5°C. Larger studies are needed to confirm these results.