Neutropenic Sepsis

Micro-organism

Wide range of possible pathogens

Duration

Depends on source and patient response.

Notes
  • Prompt diagnosis is vital to allow early rationalisation of treatment.
  • Take blood (2 sets - 20mL per set) and urine cultures before starting treatment, plus swabs from any other focus of infection, e.g. sputum, wound etc
  • Treat if neutrophil count <0.5 x 109/L or <1.0 and falling.
  • Do not wait for FBC to confirm neutropenia - start treatment if suspected.
  • Follow local protocols.
  • All haematology patients (all lymphomas, leukaemias and myelomas) should be treated as high risk
  • Patients should be assessed within 15 minutes and antibiotics given as soon as possible, within 1 hour of diagnosis of sepsis.
Neutropenic sepsis - Standard risk patients

 IV Piperacillin / tazobactam 4.5g 6 hourly

Neutropenic sepsis - High risk patients

IV Piperacillin / tazobactam 4.5g 6 hourly

plus

Gentamicin# IV (Hartford Regimen) as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app

#Consider aztreonam IV as an alternative to gentamicin if eGFR <30ml/min (CKD>4) or known/ suspected AKI. 

Review the need for ongoing gentamicin on a daily basis according to severity.

# Refer to Guidance on the use of aztreonam for more information

Neutropenic sepsis - Standard risk patients - if penicillin allergy

In Mild penicillin allergy

IV Ceftazidime 2g 8 hourly

 

In severe penicillin allergy

IV Meropenem 1g 8 hourly

(only if benefits of treatment outweigh the risk of severe allergy)

Neutropenic sepsis - High risk patients - if penicillin allergy

In mild penicillin allergy:

IV Ceftazidime 2g IV 8 hourly

plus

Gentamicin# IV (Hartford Regimen) as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app

#Consider aztreonam IV as an alternative to gentamicin if eGFR 30ml/min (CKD>4) or known/ suspected AKI. 

 

In severe penicillin allergy

Meropenem* 1g 8 hourly

(only if benefits of treatment outweigh the risk of severe allergy)

Review the need for ongoing gentamicin on a daily basis according to severity.

#Refer to Guidance on the use of aztreonam for more information

Septic Shock

IV Meropenem 1g 8 hourly