Neutropenic Sepsis

Question 1

What is Neutropenic Sepsis?

Answer 1

A Neutrophil count below 0.5 in a patient who is having anticancer treatment with either a fever (above 38) or other signs/symptoms consistent with clinically significant sepsis.

Question 2

Risk Factors of Neutropenic Sepsis (4).

Answer 2

1. Sustained Significant Neutropenia expected to last 7+ days.
2. Clinically Unstable.
3. Underlying Malignancy treated with High-Intensity Chemo.
4. Significant Co-Morbidities.

Question 3

Aetiology of Neutropenic Sepsis.

Answer 3

Common complication of cancer chemotherapy, occurring 7-14 days after chemotherapy.

Question 4

Prophylaxis of Neutropenic Sepsis.

Answer 4

Offer fluroquinolone to patients at risk.

Question 5

Investigations of Neutropenic Sepsis (4).

Answer 5

1. 2 Sets of Blood Cultures.
2. Swabs from Indwelling Lines.
3. Bloods, CXR, Serology, PCR.
4. System-Based Examinations (but no DRE until antibiotics given).

Question 6

Management of Neutropenic Sepsis (6).

Answer 6

1. Low-Risk : Oral Antibiotics - Quinolone + Co-Amoxiclav.
2. Most : Empirical IV Tazocin + Coverage for MRSA/Gram-Negatives.
3. If with Pneumonia : Macrolide.
4. Daily Measures of Fever and Baseline Bloods.
5. If persisting 48+ Hours, Meropenem +/- Vancomycin.
6. If persisting 4-6 days, investigate for fungal infection.

Question 7

What features suggest low-risk? (4)

Answer 7

1. Haemodynamically Stable.
2. No Acute Leukaemia.
3. No Organ Failure.
4. No Soft Tissue Infection.
5. No Indwelling Lines.

Question 8

When are antibiotics stopped?

Answer 8

Neutrophil count is normalised and afebrile for 48 hours and normalised bloods.