Guidelines

Prevention and management of neutropenic sepsis in patients with cancer: summary of NICE guidance

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5368 (Published 19 September 2012)
Cite this as: BMJ 2012;345:e5368

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  1. Robert Phillips, consultant paediatric oncologist1,
  2. Barry Hancock, emeritus professor of oncology2,
  3. John Graham, director3, consultant in clinical oncology4,
  4. Nathan Bromham, senior researcher3,
  5. Huajie Jin, health economist3,
  6. Sabine Berendse, information specialist3
  1. 1Leeds General Infirmary, Leeds LS1 3EX, UK
  2. 2University of Sheffield, Weston Park Hospital, Sheffield S10 2SJ, UK
  3. 3National Collaborating Centre for Cancer, Cardiff CF10 3AF, UK
  4. 4Taunton and Somerset NHS Foundation Trust, Taunton TA1 5DA, UK
  1. Correspondence to: J Graham john.graham{at}nhs.net

Neutropenic sepsis is a potentially fatal complication of treatment for cancer, with mortality rates of 2-21%.1 An investigation by the National Confidential Enquiry into Patient Outcome and Death and a follow-up report by the National Chemotherapy Advisory Group highlighted problems in the management of neutropenic sepsis in adults receiving chemotherapy.2 3 The problems included inadequate management of neutropenic sepsis leading to avoidable deaths, and the lack of systems for urgent assessment and of policies at organisation level for dealing with neutropenic sepsis. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the prevention and management of neutropenic sepsis in patients of any age with cancer.4

Recommendations

NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Information and support for patients and carers

  • Provide patients having anticancer treatment and their carers with written and verbal information, before starting and throughout their cancer treatment, on:

    • -Neutropenic sepsis

    • -How and when to access 24 hour specialist oncology advice

    • -How and when to seek emergency care.

      [Based on the experience and opinion of the Guideline Development Group (GDG)]

Training for healthcare professionals

  • Provide training on the identification and management of neutropenic sepsis to all healthcare professionals likely to be involved in the management of patients having cancer treatment. [Based on the experience and opinion of the GDG]

Reducing the risk of septic complications of anticancer treatment

  • For adult patients (aged ≥18 years) with acute leukaemias, stem cell transplants, or solid tumours in whom clinically significant neutropenia (neutrophil count ≤0.5 x 109/L) is an expected consequence of chemotherapy, offer prophylaxis with a fluoroquinolone only during the expected …

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