Neutropenic Sepsis

Question 1

Define neutropenic sepsis.

Answer 1

Neutropenic sepsis is defined by NICE as a neutrophil count of 0.5 × 109 per litre or lower, plus one of the following:

Temperature ≥ 38°C or
Other signs or symptoms consistent with significant sepsis

Question 2

Name some causes of neutropenic sepsis.

Answer 2

Recent chemotherapy (most commonly within 7 – 10 days) causes neutropenia through bone marrow suppression and is the major cause of neutropenic sepsis in cancer patients. The risk of neutropenia varies in both severity and timescale between different chemotherapy treatment regimes.

Other causes of neutropenia include:

Malignant bone marrow infiltration
Extensive radiotherapy
Bone marrow failure secondary to non-malignant disease (e.g. aplastic anaemia)
Hypersplenism
Megaloblastic anaemia

Question 3

Name some risk factors for neutropenic sepsis.

Answer 3

Patients over the age of 60
Advanced malignancy
Previous neutropenic sepsis
Mucositis (chemotherapy can induce mucosal damage and allow bacterial translocation)
Poor performance status
Significant co-morbidities (the risk increases further in the presence of multiple co-morbidities)
Indwelling central venous catheters
Corticosteroids (causes immunosuppression)
Prolonged hospital admission
Severe or prolonged neutropenia

Question 4

Describe how a patient with suspected neutropenic sepsis should be managed.

Answer 4

Patients with suspected or confirmed neutropenic sepsis should receive empirical antibiotic therapy within one hour of arrival at hospital. Antibiotic therapy must not be delayed to wait for confirmation of neutropenia.

The sepsis six care bundle should be completed.

Question 5

What may be used for both prophylaxis and treatment of neutropenia to reduce the risk of neutropenic sepsis.

Answer 5

Recombinant granulocyte-colony stimulating factor (G-CSF)

Question 6

Name some complications of neutropenic sepsis.

Answer 6

Complications of neutropenic sepsis can include:

Single or multi-organ failure (e.g. renal failure, heart failure and acute respiratory distress syndrome)
Venous thromboembolism (e.g. pulmonary embolism)
Disseminated intravascular coagulation
Opportunistic or hospital-acquired infections
Delirium
Psychological complications (e.g. anxiety regarding future infections and chemotherapy treatment)
Delays in chemotherapy leading to worse cancer outcomes