Positive blood cultures: actions to take

Call from Microbiology Lab with Positive Blood Culture result (including PICU & NICU)

Think Sepsis - prompt treatment could save this patient's life
Check observations, renal function, drug chart, allergies
Ensure handover to next team
Consider discussion with relevant Consultant on-call if clinical situation not straightforward
If patient not reviewed in person, please ensure action is documented in the clinical note

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Repeat blood cultures

If patient NOT on antibiotics: Start flucloxacillin 50mg/kg (Max 2g) iv QDS

If known MRSA positive: ADD vancomycin iv

If on co-amoxiclav, cefotaxime, ceftriaxone, ciprofloxacin or piperacillin-tazobactam and observations are stable, no action is required.
If NOT on antibiotics give ceftriaxone 80mg/kg (Max 4g) iv OD. For neonatal patients refer to neonatal guidelines.
If patient is clinically unstable give stat dose of gentamicin 7mg/kg (Max 560mg) iv.
If patient has risk factors for Multi-drug resistant Gram negative infection (ie. Previous clinical care abroad), discuss with Paed ID.
If severe penicillin allergy give ciprofloxacin 10 mg/kg (Max 400mg) iv TDS.

Consider:

Need for overnight clinical review
Discuss with relevant consultant on-call if needed

*All patients will be automatically flagged to microbiology/paediatric ID team via lab in the morning for urgent review. If advice is needed before this, contact the on-call Paeds ID consultant or Micro registrar.

Blood culture result is "Staphylococcus aureus isolated"

Blood culture result is "Gram-negative rods seen"

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