There are a few ways in which we can induce funny turns in our microbiology colleagues. One of the easiest is to say, within their earshot: "We'll stop the antibiotics if the cultures are negative".
Blood cultures are a terrible gold standard. If they're positive, for a plausible organism, then they're useful - they allow you to refine antimicrobial therapy, and make decisions about duration etc. But negative cultures?
My practice was strongly influenced by McWilliam and Riordan's review of CRP. http://ep.bmj.com/content/95/2/55.full In short, if you have two CRPs, more than 18 hours apart, and both 10 or lower, you can be pretty sure that you're not dealing with serious bacterial sepsis. The exception to this is the child who looked genuinely dreadful when they came in.
We use the following hierarchy:
- the clinical status of the child
- paired CRP
- cultures at 48 hours
The sepsis 6 principles (http://survivesepsis.org/the-sepsis-six/) will undoubtedly improve our management of the child with true sepsis - but they will also promote over treatment, unless we're really good at stopping antibiotics too.
Conflict of Interest:
I'm an editor at ADC, with responsibility for the Education and Practice edition
Conflict of Interest:
I'm an editor at ADC, with responsibility for the Education and Practice edition