Neutropenic sepsis
| Headline | |
|---|---|
| Etiology | Suspect when neutrophils < 0.5 x 109 Use MASCC score to risk stratify |
| Epidemiology | |
| Clinical presentation | fever >38C >1h (lack of fever DOES NOT rule out) |
| Pathogenesis | |
| Diagnostic investigations | peripheral + central blood cultures. ➥ blood/urine cultures, nasal swab for extended viral screen, routine bloods ➥ CXR. Avoid DRE but examine perineum ➥ High-res chest CT most sensitive for fungal infections; exclude TB |
| Management | Acute management: as with sepsis. Empirical abx within 60 min (patients should have a personalised plan) +/- gram positive cover (e.g. vancomycin); G-CSF not routine ➥ G-CSF if expected neutropenia >10 days ➥ Daily Tº + baseline bloods until apyrexial + neutrophils > 0.5x109 ➥ Persistent fever after resolution of neutropenia: untreated infection (avascular site? abx coverage?); immune reconstitution; drug reaction and other non-infective causes Prevention: Source control! (Hand hygiene, environmental cleaning, food (cooked+pasteurised, no peppers/strawberries/flowers), water management (v hot or v cold), air management = HEPA filtered |