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Culture Negative Sepsis

Andi Marmor, MD and Solomon Behar, MD
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19:19
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Andi Marmor talks with Miz and Sol about how to manage the child with culture negative sepsis.

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Andrew F. -

Is there anyway that we can get the citations for the evidence Dr. Marmor references? Thanks.

Solomon B., MD -

Here you go Andrew:

Cantey JB, Baird SD. Ending the culture of culture negative sepsis in the neonatal ICU. Pediatrics 2017; 140(4): e 20170044
Dien Bard J, TeKippe EM. Diagnosis if bloodstream infections in children. J Clin Microbiol 54:1418 –1424.
Kee PPL, et al. Diagnostic yield of timing blood culture collection relative to fever. Pediatr Infect Dis J 2016;35:846–850
Phua J. Characteristics and outcomes of culture-negative versus culture-positive severe sepsis. Critical Care 2013, 17:R202 (ADULTS)

Chris N. -

I'm a resident at a children's hospital in Canada. Loved this segment and all of the hospitalist segments you've had recently!

One thing that I've learned to keep on my differential diagnosis for culture negative sepsis that isn't improving is Hemophagocytic Lymphohistiocytosis (HLH) which is sometimes referred to as Macrophage Activation Syndrome (MAS) when it occurs in the setting of a rheumatologic illness. It's a bit of a zebra, but in the last few years I've seen at least 3 cases of children presenting in sepsis with no clear focus who ended up with HLH. The hematologists at our center say this is frequently missed. One big pearl I've learned is to consider checking Ferritin and Triglyceride levels in children with culture-negative sepsis. There aren't too many other diagnoses that will give such dramatic bumps in these lab tests, and this could really change management for these patients!

Solomon B., MD -

Great point Chris! HLH is one of those crazy diagnoses to think of when it is all going downhill and nothing seems to be working! We may have to do a segment on HLH....

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Walker, Toddler Danger. Full episode audio for MD edition 184:31 min - 87 MB - M4APeds RAP January 2019 Written Summary 310 KB - PDF

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