Neutropenic Sepsis

Question 1

What are the risk factors for neutropenic sepsis? (10)

Answer 1

• Age ≥75yr
• Recent trauma, surgery or invasive procedure within the last 6 weeks
• Recent SACT in the last 6 weeks
• Impaired immunity due to illness or drugs e.g. neutropenia, long term steroid
  treatment, haematological malignancies, immunosuppressant
• Autologous stem cell transplants <6 months
• Allograft stem cell transplant <2 years
• Indwelling lines or catheters
• People with any breach of skin integrity
• Intravenous drug misusers
• Diabetes

Question 2

Sepsis 6

Answer 2

Oxygen
Antibiotics
Fluids

Lactate
Cultures
IP/OP

Question 3

Which antibiotics?

Answer 3

Taz + Gent

or

Mero if non-severe pen allergic OR reno-toxic sact

or

Vanc + Gent + Metro in severe pen allergy

Question 4

Which are the reno-toxic SACT?

Answer 4

Cisplatin, Ifosfamide, High dose Methotrexate, Trabectedin

Question 5

Approach the patient…

Answer 5

• ABCDE
• Bloods + VBG
• Coag
• ECG
• PCR if COVID-y

Question 6

Look for source of infection

Answer 6

1. Chest
2. Abdomen e.g. RUQ, suprapubic, renal angle
3. Mouth
4. Skin e.g. breaks, rashes, herpes, cellulitis
5. Diarrhoea
6. Indwelling lines/drains

Question 7

What is the criteria for neutropenic sepsis?

Answer 7

Neutrophil count <0.5 or <1 and falling

Temp over 37.9 or 37.5 for a long period

signs and symptoms of infection

Question 8

Escalation

Answer 8

• ICU
• Oncologist on-call
• Microbiologist/virologist