Neutropenic Sepsis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Neutropenic sepsis is a life-threatening complication that occurs when an individual with neutropenia (low neutrophil count) develops sepsis. It is most commonly seen in patients undergoing chemotherapy or with bone marrow failure. Neutropenic sepsis is defined by a fever (temperature ≥38°C) or other signs of sepsis in a patient with a neutrophil count ≤0.5 x 10⁹/L.

Aetiology

Neutropenic sepsis can result from a variety of underlying causes, including:

• Chemotherapy-induced neutropenia
• Bone marrow transplantation
• Haematological malignancies
• Severe infections
• Autoimmune disorders

Pathophysiology

The development of neutropenic sepsis involves:

• Neutropenia leading to an increased susceptibility to infections
• Bacterial translocation from mucosal surfaces or catheter-related infections
• Severe inflammatory response causing systemic infection and organ dysfunction

Risk Factors

• Recent chemotherapy or radiation therapy
• Bone marrow or stem cell transplantation
• Advanced age
• Comorbid conditions such as diabetes or chronic lung disease
• Immunosuppressive therapy

Signs and Symptoms

Common signs and symptoms of neutropenic sepsis include:

• Fever (temperature ≥38°C)
• Chills and rigors
• Hypotension
• Tachycardia
• Tachypnoea
• Altered mental status
• Signs of specific infections (e.g., cough, sore throat, urinary symptoms)

Key Examination Findings

During physical examination, look for:

• Temperature, pulse, respiratory rate, and blood pressure
• Oxygen saturation
• Alert Voice Pain Unresponsive (AVPU) scale for consciousness
• Signs of dehydration (dry mucous membranes, poor skin turgor)
• Localised signs of infection (e.g., erythema, swelling, tenderness)

Investigations

Essential investigations include:

• Full blood count (FBC): To confirm neutropenia (neutrophil count ≤0.5 x 10⁹/L).
• Blood cultures: To identify the causative organism and guide antibiotic therapy.
• Serum lactate: Elevated levels may indicate sepsis.
• Renal function tests (U&Es): To assess kidney function.
• Liver function tests (LFTs): To check for liver involvement.
• C-reactive protein (CRP): Raised levels indicate inflammation or infection.
• Clotting screen: To check for coagulopathies.
• Urine, sputum, and stool cultures: To identify potential sources of infection.
• Chest X-ray (if indicated): To identify respiratory infections or complications.

Management

Primary Care Management

• Immediate referral to hospital: Neutropenic sepsis is a medical emergency requiring urgent hospital admission.
• Initial stabilisation: Ensure airway, breathing, and circulation (ABCs) are stabilised.

Specialist Management

• Sepsis Six: Follow the "Sepsis Six" protocol within one hour of presentation:
  • Administer oxygen to maintain saturation >94%
  • Obtain blood cultures
  • Administer intravenous antibiotics
  • Give intravenous fluids
  • Measure serum lactate
  • Monitor urine output
• Empiric antibiotic therapy: Start broad-spectrum antibiotics immediately:
  • First-line: Piperacillin-tazobactam (Tazocin) 4.5 grams IV every 8 hours + Amikacin 15mg/kg IV stat dose
  • Penicillin allergy (non-severe): Meropenem 1g IV every 8 hours + Amikacin 15mg/kg IV stat dose
  • Penicillin allergy (severe): Ciprofloxacin 400mg IV every 12 hours + Amikacin 15mg/kg IV stat dose + Tigecycline 100mg IV stat then 50mg every 12 hours
• Supportive care: IV fluids, oxygen therapy, and monitoring in an intensive care setting if necessary.
• Review and adjust treatment: Based on culture results and clinical response.

References

1. St George's University Hospitals NHS Foundation Trust. (2024). Neutropenic Sepsis. Retrieved from St George's NHS
2. Christie NHS Foundation Trust. (2024). Guidelines for the management of neutropenic sepsis. Retrieved from Christie NHS
3. Hull University Teaching Hospitals NHS Trust. (2024). Neutropenic Sepsis Protocol. Retrieved from Hull NHS

Back to Top