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| Fever within expected time course for identified viral infection |
- Most viral infections have < 5 days of fever. Absent other signs suggestive of a bacterial infection, additional testing for bacterial causes of fever may not be necessary within this time frame.
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- Consult infectious disease with questions about virus-specific expected durations of fever and/or testing for specific viral infections.
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| Persistent fever in a patient with or without an identified bacterial non-bloodstream infection AND blood culture obtained within the last 48 hours which is negative to date |
- Non-bloodstream bacterial infections that may cause prolonged fever include but are not limited to:
- Meningitis
- Complicated pneumonia (complex effusion, empyema, necrotizing pneumonia or lung abscess)
- Pyelonephritis
- Intra-abdominal infection
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- Evaluation for concurrent bacteremia is prudent and at least 1 blood culture should be performed.
- Repeated blood cultures after an initial culture are generally unnecessary if the patient remains clinically stable and the culture was negative.
- For more information, see Pneumonia Pathway, UTI Pathway, Meningitis Pathway.
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- An identified non-infectious source of fever
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- Post-operative within 24-48 hours
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- Fever in the first 48 hours after surgery (with or without a central venous line) is often an expected response to an inflammatory state generated by the surgical procedure.
- Assess and notify surgical team. Consider antipyretic administration.
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- Increased withdrawal assessment tool (WAT) scores
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- May be febrile due to withdrawal following a recent decrease in sedation/narcotic medications.
- Consider PRN rescue and re-evaluate patient response.
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- Dysautonomia*/central fevers
- OR
- Intracranial hemorrhage
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- Central nervous system dysfunction, such as chronic autonomic instability or acute intracranial hemorrhage, alone can cause fever.
- Discuss with surgical team (if applicable). If otherwise appropriate, administer antipyretic and continue to monitor for other signs of infection or sepsis.
- *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.
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