Neutropenic sepsis is a serious condition that typically arises in patients receiving cytotoxic chemotherapy, often serving as the only indication of a severe infection
Aetiology
Rare infections can take hold with neutropenia - pseudomonas and fungal infections (candida common)
Risk factors
Patients at high risk:
Have sustained, significant neutropenia that is expected to last more than 7 days
Are clinically unstable
Have an underlying malignancy and are being treated with high-intensity chemotherapy
Have significant comorbidities
Clinical features
Presents 7-14 days after chemotherapy
Temperature >38.5 °C, or two consecutive readings >38 °C - might be the only sign of infection
Investigations
Bloods:
Including FBC, inflammatory markers, renal and liver function
Neutrophil count of <0.5 × 109/l (or expected to fall below this level in the next 48 hours)
Two sets of blood cultures
CXR
Serology and PCR for viruses (eg. cytomegalovirus)
Sputum, urine and stool samples, CT scans etc. where clinically indicated
Management
Immediate broad spectrum antibiotics
Don’t wait for blood results before starting treatment
Even with antibiotics these patients can deteriorate and often are admitted for IV antibiotics rather than oral treatment
Standard risk patients (neutropenia + infection + NEWS ≤ 6): piperacillin/tazobactam, if penicillin allergy teicoplanin + aztreonam
High risk patients (neutropenia + spetic or NEWS ≥ 7): piperacillin/tazobactam + gentamicin, if penicillin allergy teicoplanin + aztreonam + gentamicin
Narrow to appropriate antibiotics when receive culture results
Patients starting on chemotherapy advised to phone cancer treatment helpline if they develop a fever - even if they otherwise feel well