Criteria for treatment

1. Absolute neutrophil count <1.0x109/l
2. Presence of temperature>38^oC, or clinical signs of septicaemia/obvious focus of infection.

 

• If patient fulfils criteria start 1st line treatment as soon as appropriate cultures are taken then continue assessment.
• If temperature is 37-38^oC, repeat after one hour and reassess.

 

Assessment

1. Take history incl. focal symptoms in ears, nose, mouth, throat, chest, abdomen, Hickman line and details of recent treatment.
2. Clinical examination for signs of infection-oropharyngeal, chest, Hickman line site or perianal (DO NOT perform per rectum examination).
3. Take immediate peripheral and Hickman line blood cultures.
4. Check FBC for degree of neutropenia.
5. Check U+E (to assess renal function and prior to consideration of prescribing gentamicin).
6. Send sputum, MSSU +/- stool for culture.
7. Send swabs from suspected site of infection e.g. Hickman line exit site, mouth, skin/perianal lesions etc.
8. Arrange naso-pharyngeal aspirate if presence of coryzal symptoms for viral immunofluorescence and culture.
9. Arrange CXR (urgent if respiratory distress or signs of chest infection).