Neutropenic Sepsis

Question 1

Define neutropenic sepsis.

Answer 1

Neutropenic sepsis is a potentially life-threatening complication of neutropenia (low neutrophil count). It is defined as a temperature of greater than 38°C or any symptoms and/or signs of sepsis, in a person with an absolute neutrophil count of 0.5 x 10^9/L or lower.

Question 2

Explain the aetiology/risk factors of neutropenic sepsis.

Answer 2

Characteristics of neutropenia
Rapid rate of decline of the neutrophil count increases infection risk
Age (infants and >60)
Chemotherapy
Corticosteroids
Antibiotics
Advanced malignancy
History of previous febrile neutropenia
Prolonged hospital admission
Previous surgery
Comorbidities

Question 3

Summarise the epidemiology of neutropenic sepsis.

Answer 3

The incidence of neutropenic sepsis is increasing over time, possibly reflecting the increasing use of anticancer and other immunosuppressive drug therapies The incidence of neutropenic sepsis among people with cancer ranges from three cases a month in general hospitals in the UK to over 20 cases a month in specialist haematology/oncology units.

Question 4

Recognise the presenting symptoms of neutropenic sepsis. Recognise the signs of neutropenic sepsis on physical examination.

Answer 4

Dysuria
Diarrhoea
Productive cough
Rapid decline
Chills, shivers, rigors
Febrile >38°C (may also present with hypothermia)

Question 5

Identify appropriate investigations for neutropenic sepsis and interpret the results.

Answer 5

FBC
CRP
Temperature
Urinalysis
Blood culture
Lactate