When should I consider referring a patient with bacteraemia to secondary care for further management?

Consider referring a patient with bacteraemia to secondary care for further management if:

• They meet any moderate to high risk criteria for sepsis, or if a definitive diagnosis cannot be made or the condition cannot be safely managed outside hospital NICE NG51.
• They are suspected to have neutropenic sepsis, especially if undergoing anticancer treatment, which requires immediate referral for assessment in secondary or tertiary care NICE CG151.
• They are a child with signs of severe illness such as shock, unrousable state, or signs of meningococcal disease, warranting urgent review and possible referral to paediatric intensive care NICE NG143.
• They have social or clinical factors that increase risk, such as other illnesses, parental anxiety, or prolonged illness without clear diagnosis, which may necessitate admission and specialist management NICE NG143.

In summary, referral is indicated when the patient is at moderate to high risk of severe illness or death from sepsis, when neutropenic sepsis is suspected, or when clinical severity or social factors suggest the need for hospital-based care NICE NG143,NICE NG51,NICE CG151.