Neutropenic sepsis is a relatively common complication of cancer therapy, usually as a consequence of chemotherapy. It most commonly occurs 7-14 days after chemotherapy.

It may be defined as a neutrophil count of < 0.5 * 10^9 in a patient who is having anticancer treatment and has one of the following:

• a temperature higher than 38ºC or
• other signs or symptoms consistent with clinically significant sepsis

Prophylaxis

• if it is anticipated that patients are likely to have a neutrophil count of < 0.5 * 10^9 as a consequence of their treatment they should be offered a fluoroquinolone

Management

1. antibiotics must be started immediately, do not wait for the WBC

• NICE recommends starting empirical antibiotic therapy with piperacillin with tazobactam (Tazocin) immediately

*many units add vancomycin if the patient has central venous access but NICE do not support this approach

1. following this initial treatment patients are usually assessed by a specialist and risk-stratified to see if they may be able to have outpatient treatment
2. if patients are still febrile and unwell after 48 hours an alternative antibiotic such as meropenem is often prescribed +/- vancomycin
3. if patients are not responding after 4-6 days the Christie guidelines suggest ordering investigations for fungal infections (e.g. HRCT), rather than just starting therapy antifungal therapy blindly

• there may be a role for G-CSF in selected patients