Neutropaenic Sepsis

Introduction

Appropriate assessment to identify cause and severity of symptoms

Appropriate first-line treatment: Referral to acute oncology service

Explanation to patient and family

Key points

Introduction 

More and more patients undergo chemotherapy and radiotherapy from home. All Palliative Care professionals need to be aware of the risks of lowered immune response, typically in the second week after chemotherapy. 

Appropriate assessment to identify cause and severity of symptoms 

Manifestation of sepsis in a patient who is undergoing oncology treatment can be minimal, but it must be recognised. All clinical staff should be acutely aware of the serious risk and potential rapid fatality of patients who have become neutropaenic and febrile. The routine signs of a raised temperature, a fast pulse, sweating, etc, may be absent. 

Without such vigilance, patients may suddenly deteriorate and become septicaemic which, for a significant proportion, will be fatal. 

Appropriate first-line treatment: Referral to acute oncology service 

Contact the appropriate oncology unit urgently if sepsis in a patient undergoing oncology treatment is suspected. Such patients should be transferred to the care of the specialised in-patient oncology unit for definitive investigation and management, where essential investigations can be rapidly carried out and intravenous therapy commenced with suitable monitoring. Not all Hospices are able to offer this level of care, but some large academic hospices have the facilities to treat and monitor patients with neutropaenic sepsis. Close collaboration with the attending oncologist is imperative. 

Empirical treatment of a febrile neutropaenic patient should be instigated and an appropriate antibiotic regime commenced in consultation with a local bacteriologist and the oncologist involved. Antibiotic regimes vary from region to region. 

Treatment is intravenous and for a minimum of seven days until the neutrophil count is >0.5×10 g/l. 

Explanation to patient and family 

The patient and their family members need to be involved in all decision making. They should be adequately educated about the seriousness of the situation and the potential risks involved. At times patients who have already been admitted to a Hospice may develop Neutropaenic Sepsis. 

Some patients may refuse transfer to an oncology unit and prefer to take the risk of remaining in the Hospice setting. Again this should be discussed at length with the patient to be sure that they are making an informed decision, and with their oncologist, who will advise on treatment options. 

Key Points 

• Be aware of the seriousness of this risk for patients who have recently undergone oncological treatments, particularly chemotherapy 
• Contact the appropriate oncology department urgently if sepsis is suspected 
• Transfer to specialised in-patient oncology unit for definitive investigation and management