Acute Neutropenic Sepsis — Comprehensive ICU Management

Your progress

Saved on this device.

Target exams

Red flags

• Fever and neutropenia: empirical antibacterials within 1 hour of triage (ASCO/IDSA 2018); SSC 2021 within 1 hour for suspected septic shock; ICU delay of 1 hour associated with OR of death of 10
• Gram-negative bacteraemia drives progression to septic shock — empiric anti-pseudomonal beta-lactam (piperacillin-tazobactam, anti-pseudomonal cephalosporin, or carbapenem). Never ceftriaxone as the sole agent.
• Neutropenic enterocolitis (typhlitis) is a named sepsis mimicker in immunocompromised cancer patients — do not treat it as ordinary intra-abdominal infection without source control and broad cover.
• Persistent neutropenic fever: hunt invasive fungus (CT, galactomannan). Pre-triazole empirical amphotericin B halved mortality. Voriconazole 6 then 4 mg/kg for documented IPA (52.8% vs 31.6% success; 12-week survival 70.8% vs 57.9%).
• Early source control includes removal of an infected catheter. Add MRSA-active therapy if colonised or high risk; vancomycin is the historical choice for MRSA — not routine in every febrile-neutropenic patient.