- neutropenic sepsis is a potentially fatal complication of anticancer treatment (particularly chemotherapy)
- mortality rates ranging between 2% and 21% have been reported in adults. Aggressive use of inpatient intravenous antibiotic therapy has reduced morbidity and mortality rates and intensive care management is now needed in fewer than 5% of cases in England
When to refer patients in the community for suspected neutropenic sepsis
- suspect neutropenic sepsis in patients having anticancer treatment who become unwell
- refer patients with suspected neutropenic sepsis immediately for assessment in secondary or tertiary care
confirming a diagnosis of neutropenic sepsis
- diagnose neutropenic sepsis in patients having anticancer treatment whose neutrophil count is 0.5 × 10^9 per litre or lower and who have either:
- a temperature higher than 38 deg or other signs or
- symptoms consistent with clinically significant sepsis.
Managing suspected neutropenic sepsis in secondary and tertiary care
Emergency treatment and assessment
- treat suspected neutropenic sepsis as an acute medical emergency and offer empiric antibiotic therapy immediately
- in the initial clinical assessment of patients with suspected neutropenic sepsis:
- history and examination
- full blood count, kidney and liver function tests (including albumin), C-reactive protein, lactate and blood culture
- further assessment
- try to identify the underlying cause of the sepsis by carrying out:
- additional peripheral blood culture in patients with a central venous access device if clinically feasible
- urinalysis in all children aged under 5 years.
antibiotic therapy
- beta lactam monotherapy with piperacillin with tazobactam should be offered as initial empiric antibiotic therapy to patients with suspected neutropenic sepsis who need intravenous treatment unless there are patient-specific or local microbiological contraindications
- an aminoglycoside should not be offered, either as monotherapy or in dual therapy, for the initial empiric treatment of suspected neutropenic sepsis unless there are patient-specific or local microbiological indications
Notes:
- reducing the risk of septic complications of anticancer treatment
- for adult patients (aged 18 years and older) with acute leukaemias, stem cell transplants or solid tumours in whom significant neutropenia (neutrophil count 0.5×10^9 per litre or lower) is an anticipated consequence of chemotherapy, offer prophylaxis with a fluoroquinolone during the expected period of neutropenia only
- rates of antibiotic resistance and infection patterns should be monitored in treatment facilities where patients are having fluoroquinolones for the prophylaxis of neutropenic sepsis
- do not routinely offer G-CSF for the prevention of neutropenic sepsis in adults receiving chemotherapy unless they are receiving G-CSF as an integral part of the chemotherapy regimen or in order to maintain dose intensity
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