PEDIATRICS
FEVER 0 TO28 DAYS
Most common causative organisms of SBI in this age range are reflective of
maternal vaginal flora: Group B streptococcus, enteric Gram-negative bacilli
(especially E. coli),Listeria monocytogenes, herpes virus.
SYMPTOMS/EXAM
■ Workup in this age range is based on the premise that SBI can be present in
the absence of significant historical or physical exam findings other than fever.
DIAGNOSIS
■ All patients should have a CBC with differential, blood culture, catheter
UA, urine culture, and LP.
■ CXR should be considered in those with any respiratory symptoms.
■ Stool for WBC and culture should be considered for those with diarrhea.
■ Consider testing for HSV if any signs suggestive of disseminated HSV
(vesicular rash, bloody LP not attributable to traumatic LP, significantly
elevated transaminases), or if mom has history of HSV (especially if vagi-
nal delivery with active lesions).
TREATMENT
■ Empiric intravenous antibiotics with ampicillin plus cefotaxime (gentam-
icin is an alternative) and hospitalization
■ IV acyclovir should be started immediately for those in whom HSV is suspected.
FEVER 29 TO90 DAYS
Most common causative organisms in this age range are: Pneumococci,
meningococci, Hemophilus influenza.
SYMPTOMS/EXAM
Improved developmental skills and maturing immune system allow more
reliance on physical exam findings; nonetheless, infants with SBI in this range
can still present with overall “well appearance.”
DIAGNOSIS
Well-appearing infants without focus for infection usually only need a limited
workup to include CBC with differential, blood culture, catheter UA, and
urine culture.
TREATMENT
■ Infants at “low risk” of SBI with WBC 5000–15,000/mm^3 , band/neutrophil
ratio <0.2, normal UA, and reliable caretaker can be discharged home for
close outpatient follow-up.
■ Infants not meeting low-risk criteria should have lumbar puncture done to
complete the sepsis workup with strong consideration of empiric antibiotic
coverage (ceftriaxone as single agent) and hospital admission.
FEVER3 MONTHS TO3 YEARS
Children with commonly recognized viral syndromes (eg, bronchiolitis, stom-
atitis, croup) in this age range are unlikely to have SBIs.
Remember—full sepsis w/u,
empiric antibiotics, and
admission for all febrile
infants 0 to 28 days old