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Do we overtreat patients with presumed neutropenic sepsis?
  1. Abbey King1,
  2. Sharon Irvine2,
  3. Angus McFadyen3,
  4. Chris Isles1
  1. 1Department of Medicine, Dumfries and Galloway Royal Infirmary, Dumfries, UK
  2. 2Department of Microbiology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
  3. 3akm-stats, Glasgow, UK
  1. Correspondence to Professor Chris Isles, Medicine, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP, UK; christopher.isles{at}nhs.scot

Abstract

Purpose Many aspects of the management of neutropenic sepsis remain controversial. These include the choice of empiric antibiotic, the duration of antibiotic therapy and the possibility that very low-risk cases may be managed safely with oral rather than intravenous therapy.

Study design Retrospective cohort study conducted in a district general hospital serving a population of 148 000 in south west Scotland.

Results Fifty one patients with cancer, whose neutrophil count was less than 1.0×109/L within 21 days of their last chemotherapy, were admitted as a medical emergency in 2019. All received antibiotic because of presumed neutropenic sepsis. A total of 4 patients had positive blood cultures (group 1), 12 patients had a clinical focus of infection but no clear pathogen (group 2), while 35 patients had neither (group 3). Group 3 patients were more likely to have a solid tumour, less likely to be febrile, had shorter time to neutrophil recovery and higher Multinational Association of Supportive Care in Cancer scores, though not all of these comparisons achieved statistical significance. Median intravenous plus oral antibiotic duration in group 3 patients was 9 days with median hospital stay of 7 days, raising the possibility of overtreatment. Retrospectively, 23 (66%) group 3 patients had MASSC Risk Index greater than 21 suggesting they were at low risk of complications.

Conclusions It seems likely that many low-risk neutropenic cancer patients with solid tumours could be managed as effectively and as safely with shorter courses of antibiotic, with oral rather than intravenous antibiotic, as outpatients rather than inpatients and with an overall positive impact on antimicrobial stewardship.

  • adult oncology
  • diagnostic microbiology
  • chemotherapy

Data availability statement

Data are available upon reasonable request. All data will be available by emailing the corresponding author.

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Data availability statement

Data are available upon reasonable request. All data will be available by emailing the corresponding author.

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Footnotes

  • Contributors CI had the idea for the article, AK extracted the clinical data from the electronic casesheet, AMcF undertook the statistical analyses, CI and AK wrote the first draft and all authors contributed to the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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