Sepsis, Suspected — Antibiotic Recommendations — Clinical Pathway: CICU/CCU

Suspected Sepsis Clinical Pathway — CICU/CCU

Antibiotic Recommendations

Use the CICU/CCU Suspected Sepsis Order Set
1st antibiotic within 1 hour
Remaining antibiotics within 3 hours
 
 

 

 
 

 

Infant ≤ 56 Days Hospitalized
< 72 Hours, No Central Line

 

 

Age > 56 days with ANY of the Following
  • Central line
  • Hospitalized > 72 hours
  • Recent hospitalization > 4 days within the last 2 months
  • Immunocompromised or on immunosuppressive medications
 
 

 

Cefepime
Vancomycin
 
 
Patient with suspected
intra-abdominal infection
 
 
With CNS infection (e.g., VPS)
 
 
 
 
Yes
No
Cefepime
Vancomycin
Metronidazole
Piperacillin/ tazobactam
Vancomycin
Antibiotics That Can Be Given Via IV/IM Push
Antibiotic OK to IV Push Over 5 min OK to
Give IM
Cefepime Yes Yes
Ceftriaxone Yes Yes
Ceftazidime Yes Yes
Clindamycin No Yes
Meropenem Yes No
Consider Additional or Alternative Antimicrobials for the Clinical Scenarios Below
Clinical Scenario Recommendations Comments
MDRO History Modify empiric choice based on prior susceptibilities, consider ID consult
  • MDRO history examples:
    • ESBL, CRE, or RGN under MDRO tab
    • or
    • Culture positive for one of these organisms in the past 1 year
Child Already on Broad-spectrum Antibiotics
  • Choice of antibiotic(s) and/or antifungals may be individualized, considering previous antibiotic exposures and suspected source of infection
  • Discuss with ID as needed based on child's circumstances
  • Common broad-spectrum antibiotic include any of the following:
    • Ceftriaxone
    • Ceftazidime
    • Cefepime
    • Piperacillin-tazobactam
    • Ciprofloxacin
    • Levofloxacin
    • Aztreonam
    • Meropenem
    • Imipenem
  • Vancomycin and clindamycin are not considered broad-spectrum antibiotics when administered as monotherapy
Toxin-mediated Syndrome Add Clindamycin  
Influenza Add Osteltamivir  
Risk of Fungemia Add Caspofungin
  • No clear guidelines for when to begin empiric antifungal therapy exist in non-neutropenic children, but empiric caspofungin can be considered in the presence of known risk factors and severe illness
  • Known risk factors include:
    • Broad-spectrum antibiotic exposure
    • Neutropenia
    • Central venous catheter
    • Steroid use
    • Poor gut integrity
    • TPN
    • Bone marrow transplantation
  • Please call Infectious Diseases to discuss
Allergy to First Line β-Lactam If alternative needed, ciprofloxacin replaces cephalosporin; for suspected intra-abdominal infection with or without concern for CNS infection, ciprofloxacin should be administered with metronidazole  

Re-assess the need for continued antibiotic therapy at 24-48 hours based on culture data, results of imaging studies, and clinical course.

If cultures are negative and low suspicion for bacterial infection → discontinue antibiotics.

If focal source of infection is identified, tailor antibiotics based on clinical syndrome and/or culture data, if available.

  • Consider ID consult if:
    • Concern for culture-negative sepsis to discuss duration of antibiotics and/or additional diagnostic evaluation
    • History of MDRO and/or current MDRO identified
    • Severely immunocompromised child with septic shock
    • Child with bloodstream infections (strongly encouraged, particularly in cases of S. aureus bacteremia), CNS infections, and suspected/documented fungal infections