This is a controlled document. If you are using a printed copy, check it against the guidelines site to ensure you are using the latest edition. Print copies must be destroyed after use.

Abbreviations

Any sign of severe sepsis?

• Any red flag signs
• Lactate >4.0mmol/L

If any of the above present, THIS PATIENT HAS SEVERE SEPSIS - contact responsible consultant & ITU Registrar ASAP

• History – date of last chemo, chemo regimen

• Examination – focus of infection, Temp, BP, HR, RR, O2 Sats

• Bloods – FBC, U+E, LFT, Bone profile, CRP, Lactate, blood cultures (peripheral & each lumen of central line)

• Consider - culture urine/sputum/stool/CSF/wound or line swabs

• Contact AOS FPH Bleep 5670 or WPH 07747 565447 & Epic referral (Mon- Sunday) 08:00-16:00)

• GIVE ANTIBIOTICS NOW
• Give high flow oxygen
• Give IV fluids.
• Take blood cultures (and consider culture of other potential infection sources
• Take arterial or venous blood gas (including lactate)
• Assess urine output hourly

*See Neutropenic Sepsis

Adult Antimicrobial guidelines

Any deviation from these recommended guidelines should be made by a consultant/senior member of the team and should be documented clearly in the patient notes.

Check previous microbiology results for resistant organisms – contact microbiology for advice if in doubt.

For gentamicin and teicoplanin dosing and monitoring, please refer to local policy on intranet.

The doses recommended in these guidelines are standardised. Please consult your pharmacist for adjustments dependent on weight, age, and for renal or liver impairment.

Check the PGD guideline for Piperacillin/Tazobactam in the Haematology/Oncology folder https://ourplace.xfph-tr.nhs.uk/patient-care/clinical-department-information-and-advice/pharmacy/patient-group-directions-pgds//

See version 4.0 UKONS 2023 (Suspected Neutropenic sepsis)

The Royal College of Radiologists (2020) Guidance for the management of acute oncology patients during the coronavirus pandemic. Available at:https://www.rcr.ac.uk/college/coronavirus-covid-19-what-rcr-doing/clinical-oncology-resources/coronavirus-covid-19-cancer (Accessed: 11 October 2023).

Cooksley, T. et al. (2021) 'Emerging challenges in the evaluation of fever in cancer patients at risk of febrile neutropenia in the era of COVID-19: a MASCC position paper', Support Care Cancer, 29(2), pp. 1129-1138. Available at: https://doi.org/10.1007/s00520-020-05906-y (Accessed: 11 October 2023).

Daniels, R. (2011) ‘Surviving the first hours in sepsis: getting the basics right (an intensivist’s perspective).’ The Journal of antimicrobial chemotherapy, 66(Supplement 2), pp. ii11-23. Available at: https://doi.org/10.1093/jac/dkq515 (Accessed: 11 October 2023).

Forde, C. and Scullin, P. (2017) ‘Chasing the Golden Hour - Lessons learned from improving initial neutropenic sepsis management.’ BMJ quality improvement reports, 6(1). Available at: https://doi.org/10.1136%2Fbmjquality.u204420.w6531(Accessed: 11 October 2023).

Klastersky, J. (2016) ‘Management of febrile neutropaenia: ESMO Clinical Practice Guidelines.’ Annals of oncology : official journal of the European Society for Medical Oncology, 27(supplement 5), pp. v111–v118. Available at: https://doi.org/10.1093/annonc/mdw325 (Accessed: 11 October 2023).

Kochanek, M. et al. (2019) ‘Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO).’ Annals of hematology, 98(5) pp. 1051–1069. Available at: https://doi.org/10.1007/s00277-019-03622-0 (Accessed: 11 October 2023).

Macmillan Cancer Support (2021) Sepsis (blood poisoning). Available at: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/sepsis (Accessed: 11 October 2023).

Medicine and Healthcare Products Regulatory Agency (2017) Guidance: Patient group directions: who can use them. Available at: https://www.gov.uk/government/publications/patient-group-directions-pgds/patient-group-directions-who-can-use-them (Accessed: 11 October 2023).

National Chemotherapy Advisory Group (NCAG), Whittome, J. and St Thomas’ Hospital (2009) Chemotherapy Services in England: Ensuring quality and safety Contents.

National Institute for Health and Care Excellence [NICE] (2012) Neutropenic sepsis: prevention and management in people with cancer. CG151. Available at: https://www.nice.org.uk/guidance/cg151 (Accessed: 11 October 2023).

National Institute for Health and Care Excellence [NICE] (2020) How should I access a person with suspected sepsis? Available athttps://cks.nice.org.uk/topics/sepsis/diagnosis/assessment/ (Accessed: 11 October 2023).

National Institute for Health and Care Excellence [NICE] (2020) What are the risk factors? Available at: https://cks.nice.org.uk/topics/sepsis/background-information/risk-factors/ (Accessed: 11 October 2023).

Nutbeam, T. and Daniels, R. (no date) The Sepsis Trust Clinical Tools. Available at: https://sepsistrust.org/professional-resources/our-nice-clinical-tools/ (Accessed: 11 October 2023).

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

Version Control Sheet

Related Documents