Neutropenic Sepsis Flashcards
(18 cards)
What what point during a 3 week cycle of chemo is a patient most likely to be neutropenic?
7-14 days
What is the normal neutrophil count?
1.5x10^9
What neutrophil count puts the patient at risk of infection?
1.0x10^9
What neutrophil count puts the patient at serious risk of infection?
0.5x10^9
What symptoms should a patient self screen for that indicate infection?
Hot and feverish Cold and shaky Aching joints or muscles Flu-like symptoms Cough, sore throat UTI symptoms
What is the definition of neutropenic fever?
A febrile patient where the neutrophil count is less than 1
What is the definition of neutropenic sepsis?
Diagnosed when there is evidence of sepsis ie tachycardia or hypotension in the presence of a neutrophil count less than 1 with or without fever
What are 3 microbiological causes of neutropenic sepsis?
Endogenous flora - gut biliary or urinary
What 4 non-specific symptoms indicate infection?
Anorexia
Malaise
Lethargy
Sweats
What 3 infection symptoms should you be particularly aware of?
Fever
Chills/rigours
Those related to a specific infection
Describe the systematic enquiry you should undertake
Chest - cough/sore throat GI - diarrhoea UTI - dysuria/polyuria CNS - headache SKIN - abcess Recent dental work
What 6 bedside examinations are you going to do?
Temperature Pulse BP o2 sats Respiratory rate Specific system examination
What generic investigations are you going to send off?
FBC - LFT, U&E, none profile, CRP Coagulation screen if DIC Blood cultures MSSU Stool culture if diarrhoea Throat swab if oharyngitis Sputum culture if productive cough Skin swab if infected lesion CXR
What is your initial management?
Volume recess - NaCl + dextrose
Oxygen therapy
Mouthcare
What is stage 1 antibiotic care?
Within 30 mins: broad spectrum antibiotics
Pipercillin/ Tazobactam(tazocin) 4.5g IV every 6 hours + Gentamicin 7,g/kg IV
If mild penicillin allergy – use Ceftazidime 2g IV every 8 hours plus Gentamicin 7mg/kg IV (with level taken to determine dosing interval)
If severe penicillin allergy – consider Vancomycin and Gentamicin +/- Metronidazole
What us stage 2 antibiotic care?
Meropenem 1g IV every 8 hours unless the culture suggest and alternative regimen
What would you change antibiotics?
Move to step to if the patient is still febrile after 48 house or if the patient is clinically deteriorating
What is your ongoing management protocol?
Monitor response
Usually SEWS chart
Urine output - catheterise if hypotensive
Check for positive cultures, and optimise antibiotic therapy based on sensitivities
Monitor FBC, U and E and CRP daily
May require ITU transfer if hypotension does not resolve
