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Neutropenic Sepsis. Clare Dikken Macmillan Senior Chemotherapy Nurse Sussex Cancer Network. Aims and Objectives. To understand the terminology around neutropenic sepsis (NS) To identify signs and symptoms associated with NS To have a better understanding patho-physiology around NS

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neutropenic sepsis

Neutropenic Sepsis

Clare Dikken

Macmillan Senior Chemotherapy Nurse

Sussex Cancer Network

aims and objectives
Aims and Objectives
  • To understand the terminology around neutropenic sepsis (NS)
  • To identify signs and symptoms associated with NS
  • To have a better understanding patho-physiology around NS
  • To articulate how a patient with NS should be managed initially
treatment of cancer
Treatment of cancer
  • Escalating use of cytotoxic therapy
  • Used on a wide range of tumour sites
  • Greater use in palliative care
  • Increase in the number of lines of treatment
  • Drug developments: monoclonal antibodies, small molecules3
side effects
Side effects
  • Chemotherapy affects actively dividing cells
  • It is not specific to cancer cells
  • Results in a wide range of side effects
  • Some can be life threatening
  • Neutropenic sepsis is a life threatening side effect of chemotherapy
the neutrophil and neutropenia
The neutrophil and neutropenia
  • First line defence against bacterial infection
  • Neutropenia = abnormally low neutrophil count
  • Associated with an increased risk of potentially life threatening infection
  • In general this is considered as a neutrophil count of < 1.0
  • Measured by the absolute neutrophil count
  • The nadir = 7-14 days post chemo
  • Neutropenic sepsis
sepsis
Sepsis
  • Sepsis is the clinical syndrome from SIRS
  • Inflammatory reaction results from infection
  • Micro-organisms invade the blood and release toxins
  • Decrease tissue oxygenation is an important physiological factor
  • Septic shock
slide7
SIRS
  • Signs and Symptoms
    • Hypothermia or fever
    • Shaking or chills
    • Tachycardia
    • Hypotension
    • Tachypnoea
sepsis8
Sepsis
  • Sepsis is the clinical syndrome from SIRS
  • Inflammatory reaction results from infection
  • Micro-organisms invade the blood and release toxins
  • Decrease tissue oxygenation is an important physiological factor
  • Septic shock
risk factors
Risk factors

Breakdown of skin/mucous membrane

Age >65 or<1 yr

Neutropenia

Corticosteroids and immunosuppressive therapy

Antibiotic use

Increased risk of

septic shock

Invasive procedures

Malignancy

Hospitalisation

Splenectomy

Malnutrition

Radiotherapy

Chemotherapy

slide11

SOURCE OF INFECTION

IMMUNE RESPONSE

EFFECT ON BODY

Vasodilatation,

endothelial inflammation,

increased vascular permeability,

decreased arterial

and venous tone, hypotension, myocardial depression

Recruitment of plasma cells; neutrophils, macrophages, monocytes

Release of endo/exo toxins

Release of cytokines, proand anti-inflammatory response mediators:e.g. interleukins, nitric oxide, complement, platelet activating factors, protaglandins etc

END POINT

End organ hypo-perfusion, ischemia and cell death

neutropenic sepsis13
Neutropenic sepsis
  • Incidence: depends on drug regime, patient and duration of neutropenia
  • Deaths are still occurring
  • Preventable deaths
  • Reason for deaths: delay in getting into acute hospitaldelay in diagnosisdelay to first dose of antibioticneutropenic policy not being followed
  • Many health professionals have never received any training or education on neutropenic sepsis
what can you do
What can you do?
  • Recognise at risk patients
  • Recognise early and late presenting signs and symptoms
  • Rapid referral to Acute services
  • Use HEAT as a trigger
patients at risk
Patients at Risk
  • Post chemotherapy 7-14 days
  • Haematology patients
  • Heavily pre-treated
  • Prior history of neutropenic sepsis
  • Breaches to the skin/mucous membranes
  • Co-morbid conditions e.g.advanced cancer
  • Poor general health
  • Elderly
what can you do16
What can you do?
  • Recognise at risk patients
  • Recognise early and late presenting signs and symptoms
  • Rapid referral to Acute services
  • Rapid diagnosis: FBC, blood cultures
  • Early intervention with appropriate treatment
  • Monitoring
  • Reporting
the heat trigger
The HEAT Trigger
  • H- History
  • E- Examine
  • A- Action
  • T- Treat
take home message
Take home message

Patient on chemotherapy?

Be suspicious

ACT FAST TO PREVENT DEATH