|
|
|
|
Definition
|
A temperature >38°C measured twice over a one hour period in a patient with neutropenia of < 1.0 X 109/L.
|
Management
|
Perform septic work up
|
|
 | - 1 set (aerobic and anaerobic bottles) from each lumen of CVAD
| - 1 set from peripheral blood
|
|
|
|
- sputum (if clinically indicated)
|
- faeces (if clinically indicated)
|
- swab of Central Venous Access Device exit site if there is redness / pus around the exit site
|
- swab of any other suspicious / focal lesions
|
|
|
Note: A further set of blood cultures are required within the first 24 hours if the patient continues to have a fever of >38°C. These can be taken from one lumen of a CVAD or from a peripheral vein (if no central access).
|
Commence empiric antibiotic therapy
|
Initial therapy all cases
|
| Ticarcillin - clavulanate (Timentin) 3.1g by IV infusion over 30 minutes every 6 hours.
|
|
|
|
| Gentamicin 5-7mg/kg/day by IV infusion over 30 minutes
|
|
|
|
| If Gram positive infection suspected eg. potential central line sepsis, extensive mucositis:
|
| | Vancomycin 1g by IV infusion over 120 minutes every 12 hours.
|
|
|
|
For patients with documented allergy to beta-lactam antibiotics: use meropenem monotherapy 1g by IV infusion over 1 hour every 8 hours.
|
Addition of antifungal therapy (in consultation with Infectious Diseases Physician / Clinical Microbiologist) Amphotericin B 1mg/Kg IV once daily may be commenced, if fever persists after 5-7 days of broad-spectrum antibiotics in a neutropenic patient without evidence of bacterial infection.
|
Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
|
Please remember to read our disclaimer.
|
