Neutropenic fever
Definition
Pyrexia >380 C for over one hour duration or >390C on one occasioneutropenic (<500 per cmm) adult:.
- If likely to have protracted (> 5 days) neutropenia, patient should be nursed in a room with HEPA filtered air (Ward 2D in CUH).
Background
- Bacteraemia in 30% (60% of which is Gram Positive - Staphylococcus from lines or Strep in mucositis)
- Most dangerous are Gram negative from patients bowel
- Fungal infections are uncommon and assocaited with prolonged neutropenia and broad spectrum antibiotics
- Netilmicin no longer available
- 3rd generation cephalosporin use is associated with C difficile and Vancomycin resistant enterococci
Examination
Full clinical examination but note particularly: Pulse, BP, mouth, chest, perineum, line sites, skin, fundi.
Investigations
- FBC, U&E Cr, LFT, CRP, CXR, sinus or dental x rays if symptomatic
- Blood culture - peripheral and central line if present
- Swabs from appropriate inflamed sites
- MSU if symptomatic
- Faeces if diarrhoea and/or if fungal infection suspected, check C. difficile toxin
- Aspergillus precipitans and PCR
- Serology, mouthwash, vesicle fluid for virology if indicated
Management
Actual body Weight |
IV Vancomycin Loading Dose |
IV infusion |
|---|---|---|
<40kg |
750mg |
In 250ml saline over 90mins |
40-59Kg |
1 gram |
In 250ml saline over 120mins |
60-90Kg |
1.5 grams |
In 500ml saline over 180mins |
>90kg |
2 grams |
in 500ml salivne over 240mins |
