ICU Pathway for the Evaluation/Treatment of Infants > 28 Days and Children with Severe Sepsis/Septic Shock

Antibiotic Recommendations for Patients with Severe Sepsis/Septic Shock

Use Sepsis Order Set - administer antibiotics in the order listed

1st antibiotic within 1 hour
Remaining antibiotics within 3 hours
Healthy Patient
No Central Line
Patient with any of the following:
Patient with Suspected
Intraabdominal Source
Patient already on broad spectrum antibiotics [2]
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  1. Ceftriaxone [3]
  2. Vancomycin
  3. Gentamicin
  1. Cefepime [3]
  2. Vancomycin
  3. Gentamicin
  1. Piperacillin/Tazobactam [3] [4]
  2. Vancomycin
  3. Gentamicin
  1. Imipenem
  2. Vancomycin
  3. Amikacin
CONSIDER ADDITIONAL ANTIMICROBIALS WITH THE FOLLOWING CLINICAL SCENARIOS
Toxin Mediated Syndromes Clindamycin
Risk for Fungemia [5] Caspofungin
Suspicion of Influenza Oseltamivir
REVIEW ALL CULTURES AT 48 HOURS
Negative Culture Positive Culture
Consult ID for: Consult ID for:
  • Duration of therapy
  • Persistent fever > 2-3 days
  • Definitive treatment recommendations
    after culture & sensitivity results
  • Duration of therapy
  • Persistent fever > 2-3 days
1.
Immunosuppressive
Medications
2.
Broad Spectrum Antibiotics
3.
4.
If suspected CNS source and intraabdominal source, cefepime replaces piperacillin-tazobactam and add metronidazole for anaerobic coverage
5.
Risk for Fungemia
Consider capsofungin for patients with CVL and ≥ 2 of the following: