Diagnosis
- Patients before starting and throughout their anticancer treatment, should have information on:
- Neutropenic sepsis
- How and when to contact 24-hour specialist oncology advice
- How and when to seek emergency care
- Neutropenia: neutrophil count 0.5×109 per litre or lower
- Neutropenic sepsis: temp>38 or other signs symptoms consistent with clinically significant sepsis
- Suspect neutropenic sepsis in patients having anticancer treatment who become unwell, and refer to secondary or tertiary care
Investigation
- In suspected neutropenic sepsis perform: FBC, U+Es, LFTs incl albumin, CRP, lactate, blood culture
Management
- Fluoroquinolone prophylaxis: Adults with acute leukaemias, stem cell transplant or solid tumours in whom neutropenia is anticipated due to chemotherapy (for period of neutropenia)
Managing Neutropenic Sepsis in Secondary Care:
- Treat as medical emergency
- Empirical antiobiotics: Beta lactam monotherapy with Piperacillin and Tazobactam
- Do not offer Aminoglycoside
- Do not offer empiric glycopeptide in suspected neutropenic sepsis who have central venous access
- Do not switch initial empiric antibiotics if unresponsive fever unless clinical deterioration or a microbiological indication
- Switch from IV to oral antibiotic therapy after 48 hours of treatment in low risk patients
- Do not remove central venous access devices as part of management
- Try to identify underlying cause:
- Additional peripheral blood culture if central venous access if feasible
- Urinalysis in all children aged under 5 years
- No chest X ray unless clinically indicated
Risk Assess
Using presentation features and a validated risk scoring tool:
- Low risk: outpatient antibiotic therapy for patients accounting for social and clinical situation
- High risk: review the patient’s clinical status daily, reassess the patient’s risk of septic complications
- Continue inpatient empiric antibiotic therapy in all patients who have unresponsive fever unless an alternative cause of fever is likely