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

Exclusions: ≤ 56 days old, oncology/bone marrow transplant, solid organ transplant, immunocompromising conditions (including primary immunodeficiency sickle cell disease, aplastic anemia or neutropenia) or immunosuppressive medication, and children on CRRT, ECMO or thermoregulation devices.
Concern for Sepsis
Assess the following to determine if suspicion of bacteremia is low:
  1. Fever within expected time course for identified viral infection
    • or
  2. Child has persistent fever (last fever was within less than 48 hours):
    • with or without an identified bacterial
      non-bloodstream infection
    • and
    • Blood culture obtained within the last 48 hours which is negative to date
    • or
  3. Identified non-infectious source of fever:
    • Increased WAT scores
    • Postop within 24-48 hours
    • Dysautonomia
    • Intracranial hemorrhage
Assess the following to determine if suspicion for bacteremia is moderate or high:
  • Clinical presentations not listed/considered under low-suspicion category
Low-suspicion for Bacteremia
  • Blood culture not routinely indicated
  • Defer and monitor
Continually re-evaluate for changes in child's status
Signs of Instability
Posted: September 2018
Revised: January 2023
Authors: C. Woods-Hill, MD; K. Chiotos, MD