Synopsis
Recognise neutropenic sepsis from subtle symptoms, administer empirical antibiotics within the emergency window, identify source and resistance risk, and use validated risk assessment for safe ongoing care.
- Any unwell patient receiving or recently receiving systemic anticancer therapy should be assessed for neutropenic sepsis even without fever.
- Profound neutropenia suppresses local inflammatory signs; malaise, rigors, confusion, diarrhoea, mouth pain, line discomfort or hypotension may be the presentation.
- Record ABCDE observations, venous access, lactate, full count, renal and liver function and cultures, but diagnostic sampling must not delay empirical treatment.
Key red flags
Raised lactate, mottling, oliguria or falling pressure requires immediate sepsis resuscitation and critical-care escalation.
Investigation priorities
Confirm neutropenia and accompanying marrow suppression.
Management branches
Recent anticancer treatment accompanies fever or clinically significant sepsis features.
- Use ABCDE, obtain cultures, lactate, count and organ tests, examine likely portals and begin resuscitation without waiting for a documented neutrophil result.
- Give local empirical intravenous antibiotics immediately, using piperacillin with tazobactam monotherapy when NICE criteria and patient microbiology permit.
Fever persists or recurs during prolonged profound neutropenia despite appropriate antibacterial treatment.
Key medicines
Piperacillin with tazobactamFirst-line agent: NICE recommends piperacillin with tazobactam as initial empirical intravenous beta-lactam monotherapy unless patient-specific or local microbiological factors contraindicate it. Licensed adult febrile-neutropenia regimen with normal renal function: piperacillin 4 g/tazobactam 0.5 g intravenously every 6 hours. Follow the current local neutropenic-sepsis protocol and adjust dose or interval for renal function and the adopted infusion policy.
Alternative empirical regimenMicrobiology selects a local intravenous beta-lactam or combination regimen immediately for severe allergy, resistant colonisation or a source not covered by standard monotherapy.