Blood Culture, PICU — Determining Blood Culture Acquisition in PICU/PCU Patient with Fever — Clinical Pathway: ICU

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

Determining Blood Culture Acquisition in PICU/PCU Patient with Fever

Many clinical conditions may cause fever in a critically ill child. This pathway provides guidance to aid providers in determining if a blood culture is indicated in a PICU/PCU patient with a fever (temperature ≥ 38.5°C).

Exclusions

  • ≤ 56 days old
  • Oncology/bone marrow transplant patients
  • Solid organ transplant patients
  • Immunocompromising conditions (including primary immunodeficiency, sickle cell disease, aplastic anemia or neutropenia)
  • Receiving Immunosuppressive Medications
  • Patients on continuous renal replacement therapy (CRRT)
  • Patients on ECMO
  • Patients on a thermoregulation device (Cincinnati Sub-zero Blanketrol III, Bair Hugger™)

Identifying Children at Risk for Bacteremia

Bacteremia is one cause of fever. A blood culture is the diagnostic test of choice to diagnose bacteremia but is not always required if the clinician determines the patient is at low risk for bacteremia or identifies an alternative cause for fever. Therefore, prior to obtaining a blood culture, the provider should consider not just the presence of fever, but also additional factors about the patient’s clinical status to decide if a blood culture is needed.

Common causes of fever other than bacteremia include:

  • Localized bacterial infections
  • Viral infections
  • Non-infectious conditions (e.g., opioid/benzodiazepine withdrawal, autonomic dysfunction)
  • Inflammatory states (e.g., recent surgery)

Definitions of Fever for This Pathway

Fever Temperature ≥ 38.5°C
New fever Patient was afebrile in the preceding 48 hours, but now has a fever ≥ 38.5°C
Persistent fever Patient was febrile in the preceding 48 hours, and now has a fever ≥ 38.5°C

Note

Thresholds for fever evaluation differ depending on clinical circumstances and patient population. For this pathway, a threshold of ≥ 38.5°C is used because this pathway excludes neonates, oncology patients, and immunocompromised patients in whom a lower threshold of 38°C may be used. Additionally, repeated temperatures between 38° C and 38.4°C as well as hypothermia (temperature < 36°C) may also suggest infection and clinical judgment should be used when making decisions about blood culture necessity in these scenarios.