Citation: Supportive Care in Cancer. 2019, 27(1)
Author: Forde C.; Marshall E.; Cooksley T.; Young A.; Jones P.; Clarke M.; Wilson R.H.; Coyle V.
Abstract: Introduction Following concerns regarding the management of neutropenic sepsis (NS), the National Institute for Health and Care Excellence (NICE) published the UK's first consensus clinical guideline in 2012. It provides clear recommendations for the emergency treatment and assessment of patients with suspected NS. Methods 53 local adult NS policies from across the UK were reviewed for adoption of key NICE recommendations, along with 217 responses from an electronic survey of clinicians' standard clinical practice. Results 94% of policies highlight NS as a medical emergency, with 98% defining a target 'door to needle' time for first dose antibiotics or stating antibiotics must be given immediately. 98% of clinicians also aim for 60 minutes or less to first dose antibiotics, with 47% reporting this is easy to achieve. Diagnostic criteria used in policies and by clinicians continue to vary; although 76% of clinicians report making a diagnosis is easy. Most policies encourage peripheral and central blood cultures (92%) and that several routine blood tests are checked (79%). 100% highlight that central lines do not need removed routinely and 64% that chest x-rays are not required unless clinically indicated. 85% of policies promote initial beta lactam antibioticmonotherapy (compared with 36% prior to NICE guidance), with significant reductions in empirical aminoglycosides and glycopeptides.
Conclusions Although definitions and diagnostic criteria vary this work demonstrates a consistent approach to emergency NS management across the UK. Local policies and clinicians reported practice confirms the prioritising of NS as a medical emergency and reflects natonally recommended initial investigations and antibiotic regimens.
