Thread by @BukuHaematology

1/ Neutropenic sepsis tweetorial
 
Febrile neutropenia is a common and serious complication of chemotherapy treatment and can rapidly progress to life-threatening severe sepsis. Patients with bone marrow failure conditions (e.g. AML, Myelodysplastic syndrome) are also at risk.

2/ Outcomes have improved with increased recognition of the importance of prompt treatment and better supportive care, driven by initiatives such as the Surviving Sepsis Campaign.

🔥IV antibiotics must be given within one hour in all suspected neutropenic sepsis 🔥

3/ Patient education is crucial, as is a failsafe, 24/7 contact line for prompt assessment and treatment in secondary care: once there, antimicrobials should be given within the hour.

🔬History, examination, imaging and cultures are then used to pinpoint the source.

4/ Increasing antimicrobial use and multi-drug resistant organisms are also a recognised concern in hospitals.

🦠 Be aware of local organism resistance patterns e.g where I work Pip/tazobactam resistance is over 30% - one reason why empirical gentamicin is so important🦠

5/ Also check the patient history for previous organisms and sensitivities/resistance patterns as patients often present with sepsis due to the same organism more than once

6/ Alongside clinical judgement, validated risk scores such as the MASCC score and blood tests such as procalcitonin can be used to identify patients at low risk of serious complications to facilitate early step-down to oral antibiotics, but use of these tools is not widespread

7/ #MedTwitter #FOAMed #MedEd