Do Not Miss Sepsis Needles in Viral Haystacks! Michelle Hamline, MD, PhD, MAS and Ulfat Shaikh, MD, MPH | March 27, 2024

https://psnet.ahrq.gov/web-mm/do-not-miss-sepsis-needles-viral-haystacks A five-year-old girl presented to the emergency department (ED) with symptoms of an upper respiratory tract infection. A viral swab was negative for SARS-CoV2, influenza, and respiratory syncytial virus. A throat swab was positive for group A Streptococcus. The patient returned the next day with worsening symptoms but the treating physician again did not order imaging and attributed all findings to pharyngitis. The child was sent home with a prescription for amoxicillin. On day 3 after the first ED visit, the child was brought back to the ED by ambulance with pulseless electrical activity at a heart rate of 70 bpm and oxygen saturation of 40% with no spontaneous respirations. On examination during resuscitation, there was skin mottling and petechiae. She was pronounced dead after resuscitative efforts failed. Autopsy showed bilateral pneumonia and right-sided empyema. Empyema cultures grew Streptococcus pyogenes and Klebsiella pneumoniae. The commentary discusses the importance of timely recognition and proper management of potential bacterial infections to prevent downstream morbidity and mortality from sepsis.