What are the key clinical signs and symptoms that should prompt me to suspect bacteraemia in a patient?

Key clinical signs and symptoms that should prompt suspicion of bacteraemia include:

• Fever or history of recent fever and rigors, although fever may be absent especially in older adults or immunocompromised patients.
• New-onset abnormalities in behaviour or cognition, such as confusion, delirium, or altered level of consciousness.
• Signs of systemic infection or sepsis such as tachycardia, tachypnoea, hypotension, and low oxygen saturation.
• Ill appearance including pallor, mottled or ashen skin, cyanosis of skin, lips or tongue.
• Non-blanching petechial or purpuric rash, which may indicate meningococcal disease.
• Other signs of infection such as unexplained body pain (limb, back, or abdominal), vomiting, or reduced urine output.
• In children and infants, additional signs include irritability, lethargy, reduced feeding, weak or high-pitched cry, and bulging fontanelle.
• Consider risk factors such as recent systemic anticancer treatment, immunosuppressant therapy, or breaches in skin integrity.

These signs should prompt urgent assessment and consideration of sepsis and bacteraemia, with use of structured observations and early warning scores like NEWS2 in adults to stratify risk and guide management.

References: NICE NG51,NICE NG240