Blood Culture, PICU — Clinician/Team Assessment for Infection — Clinical Pathway: ICU

Blood Culture in Patients with Fever (Non-Oncology/Non-Neutropenic) Clinical Pathway — PICU

Clinician/Team Assessment for Infection

Clinical information such as vital signs, urine output, physical exam findings, laboratory results, and radiographic studies are critical in diagnosing infection as well as determining if infection has progressed to sepsis. Early recognition of sepsis is critically important, as it allows for early antibiotic and fluid administration, which are associated with improved patient outcomes. If a patient with a fever has signs of sepsis, utilize the ED, Inpatient and PICU Sepsis Pathway.

This table outlines the common components of a clinician/team assessment for infection. Review all existing if available.

Assessment Component Existing Data Comments Recommendations
Vital signs, urine output, physical exam
  • Vital Signs/Physical Exam:
    • Temperature > 38.5°C
    • Heart rate
    • Respiratory rate
    • Blood pressure
    • Supplemental oxygen needs
    • Decreased urine output
    • Altered mental status
    • Perfusion: capillary refill < 1 second or > 3 seconds
  • Sepsis BPA may trigger an alert for these patients for a bedside huddle
Culture result(s) in last 48 hours
  • Blood culture
  • The diagnostic test for confirming bacteremia.
  • Recent blood culture results may aid in:
    • Evaluating current risk for bacteremia
    • Determining if a repeat blood culture is needed
  • Urine culture
  • Recent urine culture results may aid in confirming if a urinary tract infection is the etiology of fever
  • If obtaining a urine culture, always also obtain a urinalysis (UA). These studies may also be performed as clinically indicated to identify the source of fever.
  • Respiratory culture
  • Recent respiratory culture results may aid in identifying the bacteria causing pneumonia in patients with clinical and radiographic signs of pneumonia.
  • If obtained from an endotracheal or tracheostomy tube, cultures often represent colonization and can therefore be difficult to interpret.
  • These studies may also be performed as clinically indicated to identify the source of fever.
Radiographic studies
  • Chest X-ray
  • MRI/CT
  • Ultrasound
  • Recent imaging may aid in the diagnosis of pneumonia, intra-abdominal abscess, soft tissue or bone infection, or sinusitis.
  • These studies may also be performed as clinically indicated to identify the source of fever.
Existing laboratory studies
  • CBC
  • Inflammatory markers:
    • C-reactive protein
    • Procalcitonin
  • Recent lab results may aid in the evaluation of fever. There are no data supporting specific threshold results that would definitively indicate presence of a bacterial infection.
  • These may be obtained as clinically indicated in conjunction with clinical judgment to determine if a blood culture is needed.