PICU/PCU Clinical Pathway for Blood Culture Acquisition in Children with Fever (Non-Oncology/Non-Neutropenic)
PICU/PCU Blood Culture Acquisition in Children with Fever
Temperature ≥ 38.5°C
Temperature ≥ 38.5°C
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.
- Respiratory Culture Algorithm
- Signs of Instability
- Review all current/recent:
- Vital signs, urine output, physical exam
- Culture results in the last 48 hours
- Radiographic studies
Concern for Sepsis
Additional Guidance:
No Concern for Sepsis
Guidance for Children with or without
Central Venous Line
Guidance for Children with or without
Central Venous Line
Assess the following to determine if suspicion of bacteremia is low:
- Fever within expected time course for identified viral infection
- or
- 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
- with or without an identified bacterial
- 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
Moderate or High-suspicion of Bacteremia
- Blood culture indicated
- Guidance for Blood Culture Sources
Continually re-evaluate for changes in child's status
Signs of Instability
Signs of Instability
Posted: September 2018
Revised: January 2023
Authors: C. Woods-Hill, MD; K. Chiotos, MD
Revised: January 2023
Authors: C. Woods-Hill, MD; K. Chiotos, MD
Evidence
- Association of Diagnostic Stewardship for Blood Cultures in Critically Ill Children With Culture Rates, Antibiotic Use, and Patient Outcomes
- Multidisciplinary Team Review of Best Practices for Collection and Handling of Blood Cultures to Determine Effective Interventions for Increasing the Yield of True-positive Bacteremias, Reducing Contamination, and Eliminating False-positive Central Line-associated Bloodstream Infections
- Blood Culture Contaminants
- Importance of Blood Cultures from Peripheral Veins in Pediatric Patients with Cancer and a Central Venous Line
- Contamination Rates of Arterial Catheter Cultures
- Practical Guidance for Clinical Microbiology Laboratories: A Comprehensive Update on the Problem of Blood Culture Contamination and a Discussion of Methods for Addressing the Problem