Neutropenic Sepsis

Question 1

What is neutropenic sepsis?

Answer 1

Temperature >38.5 degrees, or two consecutive readings over 38 degrees

In a patient with a neutrophil count of less than 0.5x109 (or expected to fall below this level in the next 48 hours).

Question 2

What is the neutrophil count in someone with neutropenic sepsis?

Answer 2

Less than 0.5x109

Question 3

What is neutropenic sepsis a common complication of?

Answer 3

Cancer therapy- especially cytotoxic chemotherapy

Question 4

What is neutropenic sepsis an indication of?

Answer 4

Severe infection

Question 5

Which patients are classed as high risk?

Answer 5

• 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 chemo
• Have significant co-morbidities

Question 6

How can neutropenic sepsis present?

Answer 6

• Fever with no localising signs
• Single reading of more than 38.5 or 38 on 2 readings one hour apart
• Rigors

Question 7

What presentations are associated with neutropenic sepsis?

Answer 7

• Chest infection/ pneumonia
• Skin sepsis-cellulitis
• UTI
• Septic shock

Question 8

What is the sepsis 6?

Answer 8

• Take blood cultures
• Measure serum lactate
• Measure urine output
• Give high flow oxygen
• Give appropriate IV antibiotics
• Give IV fluids

Question 9

What are the main gram negative bacterial causes?

Answer 9

• E.coli
• Klebsiella
• Pseudomonas aeruginosa

Question 10

What are the main gram positive bacterial causes?

Answer 10

• Coagulase-negative staphylococci (e.g. staph epidermidis)
• Viridans group strep
• Staphylococcus aureus (including MRSA)

Question 11

What are the main fungal causes?

Answer 11

• Candida

* Aspergillus

Question 12

What investigations would you carry out for neutropenic sepsis?

Answer 12

2 sets of blood cultures
Swabs from any indwelling lines
Blood tests from complete blood cell count, WCC, inflammatory markers, renal and liver function.
CXR

Question 13

What would you give to a patient who was low risk?

Answer 13

Oral antibiotics

Question 14

Which oral antibiotics would you give to a patient who was low risk for neutropenic sepsis?

Answer 14

Quinolone + co-amoxiclav

Question 15

What features suggest that a patient is low risk for neutropenic sepsis?

Answer 15

• Hemodynamically stable
• Doesn’t have acute leukemia
• No organ failure
• No soft tissue infection
• No indwelling lines

Question 16

What is the main medical management for neutropenic sepsis?

Answer 16

IV treatment with piperacillin and tazobactam (tazocin)

Question 17

What would you measure daily and for how long?

Answer 17

Measure fever and baseline bloods until the patient is apyrexial and neutrophil count above 0.5x109

Question 18

What can be given as prophylaxis for neutropenic sepsis?

Answer 18

Fluoroquinolone

Question 19

When would you give prophylaxis for neutropenic sepsis?

Answer 19

When it is anticipated that patients are likely to have a neutrophil count of < 0.5 x 109 as a consequence of their treatment