The following is the Sutter Health’s clinical pathway accessed online on 6-29-2013 and is available at https://www.cpmc.org/advanced/pediatrics/physicians/sepsis-cpath.html.
See also the list of online resources Newborn Order Sets and Resources posted on the blog on 1-6-2013.
California Pacific’s clinical pathway for rule-out sepsis reflects common practices discussed in literature, but with the following adjustments:
- Age range: we will follow established ages Neonate to 1 month, 1-3months.
- We do not have a pathway for over 3 months since these kids rarely get admitted. Nonetheless, we may be involved in ED management.
- Age range: since Listeria has a tail end up to 6 weeks you may consider Ampicillin in addition to Ceftriaxone for the 4-6 week age group
A. Birth to 1 month, T>38 (Rectal)
Recommendations:
- CBC, blood culture, urine culture, LP, antibiotics (Ampicillin and Gentamycin IV, or Ampicillin and Cefotaxime IM).
- Most guidelines recommend admitting febrile infants in this age group regardless of lab results.
B. 1-3 months, T>38
Recommendations:
- UA and urine culture on all infants – if UA is positive, begin treatment for pyelonephritis and consider admission
- CBC in all infants
- Blood cx and abx (Ceftriaxone IM or IV) if WBC >15
- Lumbar puncture in any irritable or lethargic child, and consider if antibiotics are to be given.
C. 3-36 months, T>39, unvaccinated against pneumococcus
Recommendations:
- U/A and urine culture
- If T>39 for all girls <24 months and uncircumcised boys <6 months.
- Consider in circumcised boys <6 months and uncircumcised boys 6-12 months.
- If the U/A suggests UTI, begin outpatient treatment for pyelonephritis (first dose of antibiotics should be given in clinic/ER: Ceftriaxone IM or Cefixime PO)
- U/A alone can be used to screen for UTI in children > 12 months, circumcised boys >6 months
- CBC if T >39.5
- Blood culture and antibiotics (Ceftriaxone IM/IV) if WBC >15.
- Close outpatient follow-up
- LP if child is irritable or lethargic.
D. 3-36 months, T>39, vaccinated against pneumococcus
Recommendations:
- Screen for UTI as above, for T>39
- No blood tests or antibiotics necessary in well-appearing child who has received 3 doses of Prevnar, or is within 2 months of the 2nd dose.
Developed by:
Pediatric Hospitalist Group
Alan Johnson M.D.
Oded Herbsman M.D.
Bing Tschai CNS, R.N.
Andree Hest R. PH. MScPharm
A. Marmor, M.D.
Julie Tong R.N.
Andree Hest, R.PH. MScPharm
David Tejeda, M.D
