Tag: blood culture

Fever and infection

Fever and infection

Sam talks to Infectious Diseases Physician Assoc. Prof Mark Thomas about fever and the minutiae of microbiological investigations.

Cause of fever

  • Infection (cytokines)
  • Atelectasis
  • Medications including transfusion reaction
  • Alcohol withdrawal
  • PE
  • Malignancy

Approach

  • Eyeball the patient / ABCs
  • History should be directed at identifying evidence of infection across the following systems:
    • Lungs
    • Gastrointestinal
    • Genitourinary
    • Skin
    • Central nervous system
    • Surgical and cannula/drain sites
    • Note: eyes, ears, nose throat are rare infection sources in an adult hospital setting
  • Identify timing since surgery or invasive procedures.
    • Dirty surgery may cause early infection, but is rare with routine prophylactic antibiotics.
    • 2-7 days post-op increased risk of operative infection
    • 7+ days think alternatives like PE as well as intrabdominal collection and joints
  • Identify risk factors for deteriorating quickly
    • Diabetes
    • Neutropenia
    • Immune deficiency
  • Vitals + Examination
    • General inspection + peripheries
    • Lungs
    • Abdomen
    • Skin (including spinal anaesthesia sites)
    • Surgical and cannula sites
    • CNS if history supports it (though beware the non-specificity of classical meningism)
  • Investigations
    • Review microbiology for updated reports
    • FBC, U&E, CRP
    • ABG for sepsis
    • Directed culture
      • Blood
        • At least 2 setsv(4 bottles)
      • Urine
      • Faeces
      • Sputum
    • Directed imaging
      • CXR
      • CT abdo pelvis
      • Renal USS for renal abscess in urosepsis
  • Management
    • Fluids
    • Antibiotics
    • Oxygen if desaturating
    • Contact precautions
    • Investigations/culture
  • Document
    • Review past notes
    • Basics (date/time/name/reason for review)
    • Positives and pertinent negatives by system
    • Impression and differential with justification. Have you eliminated life threatening conditions?
    • Clear and specific plan
      • Who will chasing investigations?
      • Monitoring parameters
  • Consider discussion with senior and escalation, especially if called back to patient again or there are concerns about source control or neutropenia

Resources