Inpatient Post-TPIAT Fever Guideline

Statements in this guideline

1. Post-TPIAT patients are asplenic and at risk for overwhelming post-splenectomy infection (OPSI) in addition to infection resulting from post-operative complications including infection of the blood, urine, skin and lungs.

   Established

2. Post-TPIAT patients should be seen by a medical provider and treated immediately with antibiotics at the earliest sign of sepsis.

   Recommendation

3. Fever equal to or greater than 38C or 100.4F is a sign of sepsis in post-TPIAT patients.

   EstablishedSigns of sepsis may include

4. Fevers are not unexpected in the initial post-operative period in post-TPIAT patients, though warrant a medical evaluation and appropriate interventions.

   EstablishedEvaluation of the inpatient post-TPIAT patient with fever (in the ICU)

5. If the fever curve is trending up in an ICU post-TPIAT patient, obtain peripheral/central line blood cultures, CBC with differential, procalcitonin, CRP, sed rate, UA and urine culture, CXR and respiratory PCR if symptoms present.

   RecommendationEvaluation of the inpatient post-TPIAT patient with fever (in the ICU)

6. Consider broadening IV antibiotic coverage in ICU post-TPIAT patients with trending fever.

   RecommendationEvaluation of the inpatient post-TPIAT patient with fever (in the ICU)

7. Consider abdomen/pelvis CT scan if fevers persist beyond 5 days in ICU post-TPIAT patients.

   RecommendationEvaluation of the inpatient post-TPIAT patient with fever (in the ICU)

8. Post-TPIAT patients with fever outside of the ICU require emergent medical evaluation, peripheral/central line blood cultures, CBC with differential, procalcitonin, CRP, sed rate, UA and urine culture, CXR and respiratory PCR if symptoms present.

   RecommendationEvaluation of the inpatient post-TPIAT patient with fever (outside of the ICU)

9. If central line is present in a febrile post-TPIAT patient outside the ICU, start IV antibiotics with Vancomycin and Cefepime.

   RecommendationEvaluation of the inpatient post-TPIAT patient with fever (outside of the ICU)

10. If central line is not present and the post-TPIAT patient is stable, close monitoring is appropriate.

    RecommendationEvaluation of the inpatient post-TPIAT patient with fever (outside of the ICU)

11. If fevers persist in post-TPIAT patients outside the ICU, consider abdomen/pelvis CT scan.

    RecommendationEvaluation of the inpatient post-TPIAT patient with fever (outside of the ICU)