Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Neutropenic sepsis
A patient receiving anticancer treatment with neutrophils at or below 0.5 × 10⁹/L and temperature above 38°C, or any clinically significant sepsis feature, has a time-critical emergency.
Action: Use ABCDE, obtain blood cultures and baseline tests immediately, and give the locally approved empirical intravenous antibiotic without waiting for the differential count, imaging or microbiology when sampling would cause delay. Escalate shock, hypoxaemia or organ dysfunction to critical care early.
Synopsis
Recognise infection despite attenuated inflammation, deliver immediate empirical antibacterial treatment, recover useful microbiology, and respond intelligently to instability, resistance risk and persistent fever.
Treat suspected neutropenic sepsis as an acute medical emergency; a normal temperature does not exclude dangerous infection when corticosteroids, antipyretics or profound immune failure blunt fever.
NICE uses neutrophils 0.5 × 10⁹/L or lower plus temperature above 38°C or another clinically significant sepsis feature in a patient receiving anticancer treatment.
Take peripheral blood cultures and, where feasible, a separate culture from every relevant central-line lumen before antibiotics, but never sacrifice prompt treatment to complete sampling.
Key red flags
Hypotension, new confusion, tachypnoea, mottling, oliguria, rising lactate or a new oxygen requirement indicates high-risk sepsis even when fever is absent.
Fever or hypothermia
A single temperature above 38°C meets the NICE temperature element; hypothermia, rigors or an unexplained temperature trend can be equally concerning in a profoundly immunosuppressed patient.
Investigation priorities
01
Immediate blood culturesFirst step
Recover bloodstream pathogens and distinguish peripheral from catheter-associated infection before antimicrobial exposure reduces yield.
02
First-line severity panelFirst line
Confirm cytopenias, detect organ dysfunction and provide baselines for antimicrobial dosing and sepsis reassessment.
Management branches
FIRST HOURTreat before certainty
Fever, sepsis physiology or concerning focal symptoms occur during or soon after anticancer treatment.
Perform ABCDE, establish intravenous access, measure lactate and assess shock, hypoxaemia, abdominal catastrophe and line or soft-tissue source.
Take paired blood cultures and baseline bloods immediately while a second clinician prepares empirical treatment; do not await a neutrophil result.
Key medicines
Piperacillin with tazobactamGive 4.5 g intravenously every 6 hours for febrile neutropenia in an adult with normal renal function, using the stocked product instructions and local infusion policy.
Severe beta-lactam-allergy regimenUse the hospital's named severe immediate beta-lactam-allergy neutropenic-sepsis protocol, selected urgently with microbiology from the allergy phenotype, previous isolates, renal function and suspected source.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.