Neutropenic Sepsis

• Neutropenic sepsis is an oncology emergency defined as:
  a temperature of ≥38⁰C or <36⁰C OR with history of temperature at home OR with HR > 90 and /OR with RR > 20 OR hypotension
  OR generally unwell
  OR with infective symptoms.

  AND neutrophil count ≤1.0×109/L or other clinical signs of sepsis in a cancer patient who received systemic chemotherapy within the past 6 weeks or had bone marrow transplant or immunosuppression.

Risk factors:

• Duration of neutropenia
• Co-morbid conditions
• Type of disease
• Other cancer therapies/treatments
• Elderly patients
• Frequent hospitalisations
• Malnutrition
• Indwelling vascular devices

Management of Neutropenic Sepsis

• ASSUME Neutropenic sepsis until proven otherwise and start IV antibiotics as per NICE guideline ASAP
  D O O R T O N E E D L E T I M E : 1 H O U R

  1st line IV antibiotics in neutropenic sepsis as per NICE guideline:

  Beta lactam monotherapy with piperacillin with tazobactam as initial empiric antibiotic therapy for patients with suspected neutropenic sepsis if there are no patient-specific or local microbiological contraindications
  Patients with penicilin allergy – refer to local guidelines
  Avoid aminoglycoside therapy in patients who have received platinum based SACT in the last week
  Consider adding vancomycin /teicoplanin if CVAD is the suspected focus of infection.

• Fluid resuscitation Maintenance
• Oxygen
• BC
• Lactate
• Urine output

  Always make sure that the Acute Oncology Team are informed of the patient’s assessment and/or admission as soon as possible.
  Immediate advice is available from the Acute Oncology Service (bleep 8226 or AOCU on x 5483 during working hours) or the 24 Hour Oncology on call rota (consultant).
  WITHHOLD! SACT, including oral therapy, until you have discussed with the Acute Oncology or Site Specific Team.

Video about preventable death

Sidebar