Oncology patients should be treated according to Guidelines for Neutropenic Sepsis here.

Haematology patients should be treated according to the Antimicrobial Treatment Policy here.

 ALL OTHER PATIENTS: Follow guidance below

Assessment

Assess for sepsis using Sepsis 6.

If temperature >38oC and neutrophils 0.5 x 109/L or lower take the recommended investigations and start treatment as outlined below. 

Required investigations

  • Baseline bloods: FBC, U+E, LFT, CRP, Lactate
  • Blood Cultures x2
  • Other microbiological samples based on symptoms - e.g. urine for culture, viral and bacterial throat swabs, sputum for culture.

Antibiotic recommendations

Recommended total duration: 5 days if no source evident and evidence of sepsis have settled in 48-72 hours.

Antibiotic Recommendations
Source identified Treat as per guidance for that condition
Source unknown Treat as sepsis of unknown source

 

DISCUSS EARLY WITH MICROBIOLOGY

Neutropenia in a non-immunosuppressed patient can be a sign of severe sepsis.

Notes

  • Do not switch initial empiric antibiotics in patients with unresponsive fever within the first 48 hours unless there is clinical deterioration or a microbiological indication
  • Review at 48-72 hours consider stop or justify continue.
  • The neutrophil count does NOT need to be >0.5 for antibiotics to be stopped if the patient has improved within 48 hours and is afebrile for 24 hours at the time the antibiotics stop.