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

Immunocompromised Patients

Antimicrobials

Initial antimicrobial therapy for immunocompromised patients includes:

Antifungal Coverage

Caspofungin should be considered for patients with CVL AND 2 or more of the following:

Antivirals

In the presence of confirmed viral source of infection, antiviral therapy should be discussed with both Infectious Disease consultant and the consulting team that primarily follows the patient (Oncology, Immunology, Solid Organ Transplant service, etc).

Other Therapies to Support the Immune Response

Discuss use of G-CSF, GM-CSF1-3, or granulocyte infusion4 in leukopenic patients and IVIG therapy in patients with low IgG levels with the consulting team that follows the patient (Oncology, Immunology, Solid Organ Transplant service, etc.) with careful attention to the unique aspects of the patient in question. There is insufficient evidence to make broad recommendations for these therapies.

  1. Liang. Pediatr Drugs 2003; 5:673-684
  2. Meisel, et al. Am J Respir Crit Care Med 2009; 180:640-648
  3. Stephens, et al. Crit Care Med 2008; 36:448-454
  4. Grigull, et al. Support Care Cancer 2006; 14:910-916