Sepsis

Question 1

Causes of neutropenic sepsis

Answer 1

• after-effect of myelotoxicity from chemotherapy
• usually 7-14 days after chemo
• suspect in anyone unwell within 6 weeks of chemo

Question 2

Presentation of neutropenic sepsis

Answer 2

• temperature over 38C
• symptoms of severe infection

Question 3

Diagnosis of neutropenic sepsis

Answer 3

• neutrophil count less than 0.5 x 10^9
• either temperature >38C
• or <36°C, RR >20 min-1 or PaCO2 <32 mmHg (4.3 kPa), HR >90 bpm

Question 4

Investigations for neutropenic sepsis

Answer 4

• FBC to identify neutropenia
• U&Es, CRP, LFTs including albumin
• ABG for lactate measurement
• blood cultures to identify infection

Question 5

Management of neutropenic sepsis

Answer 5

• give prophylactic antibiotic e.g. fluoroquinolone, according to trust
• 1st line - Piperacillin with Tazobactam
• if unwell after 48h - Meropenem +/- Vancomycin
• after 4-6 days - order fungal investigation, give antifungal therapy
• 15L/min O2 through non-rebreathe mask
• fluids for distributive shock
• catheterise and monitor urine output

Question 6

Common causes of neutropenic sepsis

Answer 6

• Candida albicans
• Aspergillus - crescent sign on CXR
• Pneumocystis pneumonia - ground glass
• Listeria - meningitis - Amoxicillin