neutropenic sepsis Flashcards
what is the definition of neutropenic sepsis?
Fever >38 with features of sepsis in a patient with a neutrophil count of <0.5x10(9) or if the neutrophil count is expected to fall below this within the next 7 days.
what are common causes of neutropenic sepsis?
Gram - until proven otherwise as this is the most common cause.
Gram + can be more common if there are central lines in due to staph or strep.
Rarely fungal infections such as candida
Always be cautious about viral infections.
what are signs and symptoms of neutropenic sepsis?
Temp >38 but be aware of cold sepsis
Signs of an underlying infection ie urinary symptoms or abdominal pain
Fever
Confusion
RR>20
HR>90
Hypotension
Urine output <0.5ml/kg/hr
what investigations should be done for neutropenic sepsis?
Bedside: Observations History: information about chemotherapy regime, cycle and disease extent. Typically get neutropenic at 5-10 days after last cycle Urine Dip MC&S of urine Stool cultures ECG
Blood tests: VBG (Lactate!) FBC U&E's CRP LFT Clotting screen
Imaging:
CXR
Cardiac echo if new murmur or features of IE. More concerning if confirmed staph infection
If staph infection and localised back tenderness do an MRI spine for discitis.
Special tests:
Blood cultures
Cultures of any lines
Lumbar puncture if indicated.
what is the management of neutropenic sepsis?
Sepsis six
The main change between normal sepsis guidelines and neutropenic sepsis guidelines is antibiotic choice.
In neutropenic sepsis tazocin is used as it’s a good broad spec. Often given with extra G- cover such as aminoglycosides. If high staph risk include vancomycin or another glycopeptide.
when is G-CSF sometimes used?
Therapeutic use:
- High risk of neutropenic sepsis (WCC<0.1, Fever >10 days), pneumonia, abscess or fungal infections, multi-organ failure
secondary prophylaxis:
- chemo induced neutropenia
when is prophylactic Abx used?
When the patients neutrophil count is <0.5x10(9) then offer fluoroquinolone.
what are causes of neutropenia?
Chemotherapy Congenital Infections ie HIV/TB Autoimmune causes ie aplastic anaemia Direct malignancy infiltrating the bone marrow
