Haematology-Oncology · Pathway 60

Neutropenic Sepsis

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Key points

Definition (NICE CG151): neutrophil count 0.5 × 10⁹/L OR LOWER in a patient having anticancer treatment, PLUS either a temperature above 38ºC or other signs/symptoms of clinically significant sepsis · note NICE's threshold is 'or lower', not 'below 0.5' · commonest 7–14 days after chemotherapy.
Start antibiotics IMMEDIATELY — do not wait for the WBC.
NICE: empirical piperacillin with tazobactam (Tazocin) immediately.
Many units add vancomycin with central venous access — NICE do not support this.
Do NOT offer an aminoglycoside, as monotherapy or in dual therapy, for initial empiric treatment unless there are patient-specific or local microbiological indications.
Prophylaxis: offer a fluoroquinolone to ADULTS WITH ACUTE LEUKAEMIAS, STEM CELL TRANSPLANTS OR SOLID TUMOURS in whom significant neutropenia (0.5 × 10⁹/L or lower) is an anticipated consequence of chemotherapy, during the expected period of neutropenia only — not to every patient · follow MHRA restrictions on fluoroquinolones.
Do not routinely offer G-CSF to PREVENT neutropenic sepsis in adults on chemotherapy, unless it is an integral part of the regimen or needed to maintain dose intensity.