Temperature >38 °C or signs of sepsis in a patient with neutrophils <0.5 ×10⁹/L, usually 7–14 days after chemotherapy.
Investigations
- • Blood cultures (peripheral and each lumen of any central line)
- • FBC, U&E, LFT, CRP, lactate
- • CXR, urine culture, swabs of any line site
Management
- • Empirical piperacillin-tazobactam within 1 hour — do NOT wait for the neutrophil count
- • Add gentamicin or switch to meropenem if shocked or known resistance
- • Fluid resuscitation and sepsis six
- • Add vancomycin if line infection suspected
- • G-CSF in selected high-risk patients
Complications
- • Septic shock
- • Multi-organ failure
- • Treatment delay to cancer therapy
Clinical pearls
- • Any unwell patient within 6 weeks of chemotherapy is neutropenic sepsis until proven otherwise
- • Fever may be absent in patients on steroids
Related in WardRound
Educational — verify locally.
