Synopsis
Recognise infection despite muted inflammatory signs, deliver immediate empirical antibiotics and resuscitation, identify sources and resistant or fungal risk, and select ongoing inpatient or supported ambulatory care safely.
- Suspect neutropenic sepsis in any unwell person receiving or recently receiving systemic anticancer treatment, even when fever and focal inflammatory signs are absent.
- NICE defines it as neutrophils 0.5 × 10^9/L or lower with temperature above 38°C or other clinically significant sepsis features, but treatment begins before the laboratory result when suspicion is credible.
- First-line assessment is simultaneous ABCDE, full observations, lactate, FBC, renal and liver tests and peripheral plus relevant line cultures; sampling must not postpone antibiotic delivery.
Key red flags
Hypotension, rising lactate, mottling, oliguria, confusion, hypoxaemia or respiratory fatigue indicates organ dysfunction and needs senior resuscitation and critical-care review.
Rigors, hypotension, tachypnoea, confusion, oliguria or abrupt functional decline after treatment is compatible with neutropenic sepsis despite normal temperature.
Investigation priorities
Identify organ dysfunction and establish the urgency and response to resuscitation.
Management branches
Recent anticancer treatment accompanies fever, rigors or clinically important sepsis features.
- Use ABCDE, monitoring and intravenous access; obtain lactate, FBC, renal and liver tests and peripheral plus line cultures without allowing difficult sampling to delay treatment.
- Give the local empirical intravenous regimen immediately, using piperacillin/tazobactam monotherapy when NICE and patient microbiology support it.
Key medicines
Piperacillin/tazobactamWith normal renal function, give piperacillin 4 g with tazobactam 0.5 g intravenously every 6 hours for adult neutropenic fever, using the current local infusion policy and adjusting dose or interval for renal function.
Alternative empirical antibacterial regimenFor immediate severe beta-lactam allergy or known resistant colonisation, give the locally specified intravenous alternative at full sepsis doses immediately, with microbiology-directed renal and weight adjustment.