Neutropenic Sepsis

🧭 When to suspect

Neutropenic sepsis is a life-threatening infection arising in a patient whose neutrophils have been depleted by anticancer treatment – most often cytotoxic chemotherapy. NICE defines it as a neutrophil count of 0.5 × 10⁹/L or lower together with either a temperature higher than 38°C or other features of clinically significant sepsis, in a patient having systemic anti-cancer therapy (SACT). Adult mortality is reported at 2–21%, and most episodes present in the community because chemotherapy is usually given as a day case.

In the surgery you will rarely have the neutrophil count, and you must not wait for it. Treat any patient who has had chemotherapy within the last 6 weeks and is febrile or simply unwell as neutropenic sepsis until proven otherwise. Risk is greatest at the neutrophil nadir, typically 7–14 days after a cycle. A normal or paracetamol-suppressed temperature does not exclude it – septic shock can occur with no fever at all.

Suspicion should be higher still with deeper, longer neutropenia (haematological malignancy, stem-cell transplant), an indwelling central line, the first one or two cycles of a regimen, and concurrent corticosteroids that blunt the fever. The single action that saves lives is immediate referral for intravenous antibiotics.

Source: NICE CG151