Febrile Infant — Positive Culture Results — Clinical Pathway: Emergency Department and Inpatient

Febrile Infant Clinical Pathway — Emergency Department and Inpatient

Positive Culture Results

  • If any HSV PCR+, consult ID
  • Refer to antimicrobial and rationale table for antibiotic choice and dosing
  • If no prior attempts, perform LP on floor in a timely fashion before initiation of antibiotics if not already started. For prior unsuccessful LPs, consider POC US to evaluate for hematoma before reattempting or referral to IR. (Considerations for Performing Lumbar Puncture)
Age (Days) Urine Culture +
Diagnostic Imaging and Prophylactic Antibiotics		 Blood Culture + CSF Culture +
0-21
  • Target antibiotics based on speciation, sensitivities
  • RBUS
  • Consider urology consult
  • Repeat blood culture (before changing antibiotics if applicable)
  • ID consult
  • Consider broadening coverage pending speciation, sensitivities
  • Ensure meningitic dosing
  • ID consult
    • Consider broadening coverage pending speciation/sensitivities
22-28
  • If not previously done:
    • Consider LP based on evolving clinical signs and symptoms
    • Start empiric antibiotics
  • Target antibiotics based on speciation, sensitivities
  • RBUS
  • Consider urology consult
  • Repeat blood culture (before changing or starting antibiotics if applicable)
  • If not previously done:
    • Perform LP
    • Start antibiotics
  • ID consult
  • Consider broadening coverage pending speciation, sensitivities
29-56
  • Target antibiotics based on speciation, sensitivities
  • RBUS
  • Consider urology consult
  • Repeat blood culture (before changing antibiotics if applicable)
  • ID consult
  • Consider broadening coverage pending speciation, sensitivities
  • Perform LP, if not previously done