Neutropenic Sepsis Flashcards
Define neutropenic sepsis
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)
Risk factors for neutropenic sepsis
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
Gram-negative bacteria involved in neutropenic sepsis
E.coli
Klebsiella
Enterobacter spp. - can get carbapenem-resistent strains (CRE)
Pseudomonas aeruginosa
Acinetobacter
Gram-positive bacteria involved in neutropenic sepsis
Coagulase-negative staphylococci (e.g. staph epidermidis)
Staphylococcus aureus (including MRSA)
Enterococcus (including VRE)
Viridans group strep
Strep pneumo
Group A streptococci
History in neutropenic sepsis
Type and timing of chemo regimen and any other immunosuppressive medication being taken.
Localizing symptoms e.g right lower-quadrant pain associated with neutropenic enterocolitis
Recent infections and antibiotics used
Latent infections are known to reactivate (e.g. TB), sick contacts, blood transfusions
Co-morbidities
Any intravascular devices
Examination in neutropenic sepsis
DRABCDE
Systems-based examinations
ENT
Fundoscopy
DO NOT perform DRE until antibiotics given)
Investigations in neutropenic sepsis
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
Serology and PCR for viruses e.g. CMV
Sputum, urine, stool samples, CT scans etc. where clinically indicated
Management of neutropenic sepsis
ABCDE
If low risk can give oral antibiotics (quinolone + co-amoxiclav)
Most patients need empirical IV treatment with piperacillin and tazobactam (tazocin), with added coverage for MRSA or gram-negatives if thought at risk
Macrolide should be added if diagnosed with pneumonia (to cover atypical organisms)
Daily measures of fever and baseline bloods until patient is apyrexial and neutrophil count above 0.5x109
What features suggest patients with neutropenic sepsis are low-risk?
Haemodynamically stable
Doesn’t have acute leukaemia
No organ failure
No soft tissue infection
No indwelling lines
When can antibiotics be stopped in neutropenic sepsis?
Neutrophil count normal
Afebrile for 48 hours
Blood tests have normalised
