Fever

1.  New Fever in PICU
 Infection in PICU
 Serious Focal infection
 Isolation
 Antimicrobial drugs

2. New Fever in PICU
Nosocomial Infection
Mohamed Abdallah
(2018)

3. Fever in PICU
1. Ventilator acquired Pneumonia
2. Catheter related blood stream infection
3. Urinary tract infection
4. CNS Infection

4. 1.Ventilator acquired Pneumonia
 Clinical Signs:
• New/increased production of purulent sputum
• Chest rales/bronchial breath sounds/dullness
• Radiographic infiltrations, consolidations, pleural effusion,
cavitations not attributable to any other etiology
 Usual Organisms:
• Pseudomonas aeruginosa
• Staph aureus (MRSA)
• Klebsiella
• E Coli
• Enterococci
• Fungus

5. 1.Ventilator acquired Pneumonia con.
Laboratory Diagnosis:
• Leukocytosis
• Suggestive CXR
• Positive cultures of ET aspirate
 Prevention:
• Use disposable ventilator tubing
• Strict sterile precautions during suctioning
• Postural drainage/ chest physiotherapy
• Early extubation
 Treatment: Appropriate Ab (as guided by C/S results) for adequate duration

6. Additions
• Prevention of Aspiration of pathogenic organisms from the oropharynx (The instances of VAP that
appear within 4 days of intubation are most likely caused by pathogens that have been dragged into
the airways during the intubation procedure.)
• Oral decontamination (usually with antiseptic agent chlorhexidine) is now a standard measure in all
ventilator-dependent patients.
• Routine Airway Care: Endotracheal suctioning can disrupt the biofilms and dislodge microbes
colonizing the inner surface of tracheal tubes, which introduces pathogens into the lower airways. For
this reason, endotracheal suctioning is not recommended as a routine procedure, but only when
necessary to clear secretions from the airways.
• Clearance of Subglottic Secretions: significant reduction in the incidence of VAP when subglottic
secretions are cleared using specialized endotracheal tubes ((e.g. Mallinckrodt TaperGuard Evac Tube,
Covidien, Boulder, CO)

8. 2. Catheter related blood stream infection
 Clinical Signs:
• Recrudescence of fever after afebrile period
• Redness/Thrombophlebities at local site
 Usual Organisms:
• CONS
• Enterococci
• Fungi
• Staph aureus
• Pseudomonas
 Laboratory Diagnosis:
•Leukocytosis
• + blood culture from blood draw from catheter and simultaneously from peripheral site

9. 2. Catheter related blood stream infection
con.
Prevention:
• Strict enforcement of hand washing protocol
• Use chlorhexidine and alcohol for cleaning at time of insertion
• Prefer subclavian > internal jugular >femoral line
• Avoid use of transparent dressing for fixation (moisture retention)
• Handling by experienced healthcare staff
 Treatment:
Appropriate Ab (as guided by C/S results) for adequate duration

10. 3. Urinary tract infection
 Clinical Signs:
• Recrudescence of fever after afebrile period
 Usual Organisms:
• Gram negative enterics
• Fungi
• Enterococci
 Laboratory Diagnosis:
• Without an idwelling catheter:
1. Clean catch midstream urine growth > 100,000 CFU/ml
2. Any growth from suprapubic specimen
• With an idwelling catheter: Bacterial counts >100 from the urine from catheter port

11. 3. Urinary tract infection
Prevention:
• Strict enforcement of hand washing protocol
• Use of urinary catheter for shortest possible period
• Use of Abs.before any invasive urological procedure
• Development of catheter material that prevent bacterial growth
 Treatment:
Appropriate Ab (as guided by C/S results) for adequate duration