Blood Culture Acquisition in Children with Fever (Non-Oncology/Non-Neutropenic) Clinical Pathway – PICU and PCU

Goal and Metrics

Provider Resources

Related Pathway
- Sepsis, ED, Inpatient and PICU

Determining Blood Culture Acquisition in PICU/PCU Children with Fever ≥ 38.5°C

Exclusion Criteria

Age ≤ 56 days old
Oncology patient
Sickle cell disease
Moderate to severe immunocompromise
CRRT, ECMO, or thermoregulation devices
Baseline temperature dysregulation

Team Assessment

Vital signs, urine output, physical exam
Culture results from previous 48 hrs
Radiographic studies
Signs and symptoms concerning for septic shock

Concern for Sepsis
PICU Sepsis Pathway

No Concern for Sepsis

Assess the Following to Determine if
suspicion of bacteremia is low:

Fever within expected time course for identified viral infection
or
Persistent fever
and
Blood culture within last 48 hrs negative to date
or
Identified non-infectious source of fever:
- Increased WAT scores
- Postop within 24–48 hrs
- Dysautonomia
- Intracranial hemorrhage

Low Suspicion of Bacteremia
Blood culture not routinely indicated

Moderate Suspicion of Bacteremia

Blood culture indicated
Guidance for Blood Culture Sources
Do not delay antibiotics

Monitor for signs and symptoms of sepsis

Posted: September 2018
Last Revised: August 2026
Authors:
- C. Woods-Hill, MD
- K. Chiotos, MD
- S. Watts, CRNP
- C. Osborne, MD
- C. DeStefano, RN
- M. Bernstein, ACCNS-P
Editors: Clinical Pathways Team

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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PICU/PCU Clinical Pathway for Blood Culture Acquisition in Children with Fever (Non-Oncology/Non-Neutropenic)

Evidence