SAQ 420 – Oncology – febrile neutropenic sepsis after chemotherapy
Model Answer
Oncology – febrile neutropenic sepsis after chemotherapy.
a. Treatment priorities
- Treat as febrile neutropenic sepsis with shock.
- Give high-flow oxygen as required and monitor closely.
- Obtain IV access and give crystalloid resuscitation with reassessment; escalate to vasopressors/ICU if shock persists.
- Give broad-spectrum IV antibiotics urgently according to local neutropenic sepsis guidelines.
- Treat vomiting with antiemetics and correct dehydration/electrolyte disturbance.
- Look for and control the infection source, including line infection.
b. Investigations
| Investigation | Justification |
|---|---|
| FBC with differential | Confirms neutropenia and thrombocytopaenia/anaemia. |
| Blood cultures from peripheral and central-line sites if present | Identifies bacteraemia and guides antimicrobial narrowing. |
| VBG/ABG with lactate | Assesses shock, acidosis, and severity of sepsis. |
| EUC, LFT, calcium, magnesium, and glucose | Detects chemotherapy/vomiting-related derangement and supports safe drug dosing. |
| Urine MCS, CXR, and other source-directed cultures/imaging | Looks for the infection focus and source control needs. |
c. Antibiotic choice factors
- Local neutropenic sepsis guideline and local resistance patterns.
- Likely source, including line infection, pneumonia, urinary, abdominal, or skin focus.
- Severity of illness and need for antipseudomonal cover.
- Previous colonisation or infection with resistant organisms.
- Allergy history, including beta-lactam allergy.
- Renal/hepatic function and recent antibiotic exposure.
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