Bacteremia Evaluation Note

Date/Time: [Encounter date and time] (If documentation time differs from encounter time, list both)

Author/Service: [Author name/role and service] (e.g., ID Consult, Hospital Medicine)

Patient: [Name / MRN / age / sex / location] (Format per institutional policy)

Encounter Type: [initial consult / follow-up] | [inpatient / observation]

Reason for Note

[Brief statement of consult question or purpose] (e.g., evaluation and management plan for bacteremia; clarify source, clearance plan, and definitive duration)

Clinical Summary

[Single-sentence summary including: organism or preliminary Gram stain; number of positive sets/bottles; key host factors (relevant comorbidities, immunocompromise, intravascular or implanted devices, IVDU if relevant); clinical severity (stable vs sepsis/septic shock); most likely suspected source]

Focused History

[Symptom onset and timeline including fever/rigors, hypotension, and course relative to cultures and antibiotics with dates/times when available]

[Localizing symptoms relevant to source identification: urinary, pulmonary, abdominal, skin/soft tissue, back/spine, joint, headache, neuro deficits. Recent procedures or device events such as line placement/manipulation, dialysis access issues, surgery, dental work. Antibiotics already received with start date/time. Device/hardware inventory including prosthetic valves, vascular grafts, orthopedic hardware, cardiac devices—explicitly state if none present.] (Include only information relevant to source identification, endovascular risk, and antibiotic decisions. End with one sentence summarizing suspected source and key uncertainties.)

Blood Culture Timeline

(Add an entry for each culture set. If bottle-level or time-to-positivity data are unavailable, state "Not available." Do not infer.)

• Set [# or label]: [Collection date/time]

  • [Draw site: peripheral / catheter lumen / arterial line / unknown]
  • [Positivity pattern: e.g., 2/2 sets positive; bottle-level detail if available]
  • [Organism identification level and organism if known: Gram stain only / species-level / PCR ID panel]
  • [Time to positivity if available]
  • [Susceptibility status: pending / key results]
  • [Interpretation: true bacteremia / possible contaminant] (Brief rationale)
• (Add additional culture sets as needed)

[Pending blood cultures: list collection date/time and draw site] (Only include if pending cultures exist)

Other Relevant Microbiology

(Include only if source-related cultures exist; omit entire section if none relevant.)

• [Specimen type and site] — [Collection date] — [Organism or Gram stain] — [Matches blood culture: yes / no / unknown] — [Susceptibility: pending / key results]
• (Add additional source-related cultures as applicable)

Contamination Assessment

(Include only when a common skin commensal or low-virulence organism is isolated; omit otherwise.)

• [Total sets drawn and number positive]
• [Peripheral vs line draw details]
• [Clinical correlation: fever, leukocytosis, hemodynamics]
• [Intravascular devices or hardware present]
• Conclusion: [Treating as contaminant / Treating as true bacteremia] — [Brief rationale. If uncertain, state plan to resolve: repeat cultures, observation period.]

Clinical Status

[Hemodynamics including BP/HR trends and vasopressor status if applicable. Fever curve with Tmax and trend. Key labs relevant to antibiotic selection and dosing: WBC trend, renal function for dosing, other source-relevant markers. Weight if dosing-dependent.] (Keep concise; avoid full lab recitation.)

Focused Examination

(Document only elements actually performed and relevant to bacteremia workup. Do not imply negative findings if not assessed.)

[General appearance. Cardiac auscultation with murmur status and whether new vs known. Endocarditis stigmata if assessed. Skin findings including embolic lesions, line sites, abscesses. Spine tenderness if assessed. Joint findings if assessed. Neurologic deficits if assessed. Device and vascular access site examination.]

Assessment and Plan

Bacteremia: Working Diagnosis

[Working diagnosis: e.g., Bacteremia due to [organism] / Bloodstream infection suspected, organism pending] — [confirmed / suspected] — [uncomplicated / complicated] (Designate uncomplicated only if criteria explicitly met; document how endocarditis and metastatic infection were excluded.)

Clearance status: [Last positive culture date/time; most recent negative culture date/time if any; or "clearance not yet documented"]

Suspected Source

• Most likely: [Source] — [Supporting evidence: symptoms, exam, imaging, matching cultures, device findings]
• Alternatives: [Alternative source 1 with factors that would increase/decrease likelihood]; [Alternative source 2 with factors that would increase/decrease likelihood]
• Source investigations: [Imaging, consults, or targeted cultures ordered or needed]

Clearance Strategy

• Repeat culture plan: [e.g., Repeat 2 peripheral sets now, then every 24–48h until negative; if catheter-related infection suspected, obtain paired peripheral and catheter-lumen cultures]
• Clearance anchor: [Define Day 1 for duration counting, e.g., "Day 1 = date of first negative blood culture"]
• (If no routine repeat cultures planned, state rationale and criteria that would prompt re-culturing)

Source Control

• Completed: [Catheter removal/exchange, drainage, debridement, device management]
• Pending/planned: [Interventions with responsible team and timeframe]
• (If device retention planned, document rationale and adjuncts: lock therapy, prolonged therapy, enhanced monitoring)

Endovascular and Metastatic Infection Evaluation

• Endocarditis risk features present: [prosthetic valve / prior IE / intracardiac device / vascular graft / IVDU / persistent bacteremia / embolic phenomena / new murmur / unknown source / none identified]
• Echo plan: [TTE / TEE] — [planned / completed with date and result] (If deferred, document rationale and triggers for escalation.)
• Other endovascular concerns: [Suppurative thrombophlebitis, infected graft, mycotic aneurysm, device infection—document relevant imaging or specialty involvement, or state none suspected]
• Metastatic infection screen: [Symptom screen results: back pain, joint pain/effusion, neurologic symptoms] — [Targeted workup plan based on symptoms and organism] (Do not state "no metastatic infection" without documenting basis.)

Antimicrobial Plan

• Current regimen: [Agent, dose, route, frequency, start date/time, indication] (Note renal/hepatic dosing adjustments and relevant allergies.)
• Definitive regimen: [Preferred agent(s) once susceptibilities known] — [De-escalation rationale] — [Route: IV only / IV-to-PO stepdown with criteria] — [Combination therapy rationale if applicable]
• Duration plan: [Total planned duration] starting [Day 1 definition with date], estimated end date [DATE]. (List factors that would extend: persistent bacteremia, endocarditis, metastatic focus, retained hardware, inadequate source control.)
• Monitoring: [Labs to trend, drug levels if applicable, toxicity monitoring, IV access needs for prolonged therapy]

Follow-up and Disposition

• Inpatient: [Follow-up plan for pending cultures, imaging, and interventions]
• Outpatient: [ID clinic, OPAT, specialty follow-up as indicated]
• Communication: [Key discussions completed with primary team, consultants, other services]
• Discharge dependencies: [Culture clearance, source control completion, definitive antibiotic plan, reliable access and monitoring]

(Use explicit placeholders—"Pending," "Not yet resulted," "Unknown," "Not assessed"—rather than leaving fields blank. Do not state conclusions such as "bacteremia cleared" or "endocarditis ruled out" without documenting supporting evidence and dates. Ensure culture timelines and antibiotic day counts are accurate to current note date.)