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Recommended sepsis evaluation for febrile young infants 7 to 90 days old at elevated risk for invasive bacterial infection

Recommended sepsis evaluation for febrile young infants 7 to 90 days old at elevated risk for invasive bacterial infection
Patient characteristics Studies
All patients
  • CBC with differential
  • Blood or serum glucose (to permit comparison with CSF glucose)
  • Procalcitonin or C-reactive protein (optional)
  • Blood culture
  • Urinalysis
  • Urine culture (by bladder catheterization or suprapubic aspiration)
  • COVID-19 PCR (nasal swab)
  • Chest radiograph (if respiratory signs or symptoms present)
  • Stool culture (if diarrhea or stool containing blood or mucus)
  • CSF cell count with differential
  • CSF glucose and protein
  • CSF for bacterial culture and Gram stain
  • CSF PCR as indicated based upon clinical risk:
    • Enterovirus studies during time of high prevalence or in patients with CSF pleocytosis
    • HSV in infants with clinical findings or increased risk of maternal HSV transmission
  • CSF for viral culture if there is pleocytosis; if there is a limited CSF sample, we prioritize PCR over viral culture
Signs of septic shock*
  • Add:
    • PT, aPTT, INR
    • Fibrinogen and D-dimer
    • Serum lactate
    • Serum total bilirubin and ALT
    • Ionized calcium
Findings of HSV infection or at risk due to exposure (maternal active genital lesions)
  • Add:
    • Surface viral cultures from the conjunctivae, mouth, nasopharynx, and rectum
    • Swab or scraping from skin vesicles or mucous membrane lesions for direct immunofluorescence assay and viral culture
    • Blood PCR for HSV
    • Serum AST and ALT
Findings of bronchiolitis
  • Add rapid RSV testΔ
High regional prevalence of influenza
  • Add influenza PCRΔ
For patient characteristics that indicate an elevated risk for invasive bacterial infection and the need for a full sepsis evaluation, refer to UpToDate content on the outpatient evaluation of neonates and febrile young infants 7 to 90 days old.
CBC: complete blood count; CSF: cerebrospinal fluid; HSV: herpes simplex virus; COVID-19: coronavirus disease 2019; PCR: polymerase chain reaction; PT: prothrombin time; aPTT: activated partial thromboplastin time; INR: international normalized ratio; ALT: alanine aminotransferase; AST: aspartate aminotransferase; RSV: respiratory syncytial virus.
* Other causes of ill appearance in addition to sepsis include congenital heart disease, congenital adrenal hyperplasia, inborn errors of metabolism, malrotation with volvulus, and a variety of other conditions. Refer to UpToDate content on approach to the ill-appearing infant younger than 90 days of age.
¶ Serum alanine transaminase and aspartate transaminase to identify elevation in association with HSV-associated hepatitis; although these studies can also be elevated in patients with disseminated enteroviral infection or in septic shock.
Δ Do not use RSV or influenza test results to determine the need for antibiotics or antiviral agents to treat influenza in ill-appearing febrile young infants.
Graphic 134330 Version 1.0

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