GGC Medicines


Adult Therapeutics Handbook

Immunocompromised patients with fever

Immunocompromised patients with fever

Immunocompromised patients can include the following:

  • Received chemotherapy within the previous 3 weeks
  • On high dose steroids e.g. prednisolone >15mg/day for >2 weeks*
  • On other immunosuppressive agent e.g. anti-TNF, cyclophosphamide
  • Transplant patient (solid organ or bone marrow)
  • Primary immunodeficiency

Neutropenic sepsis definition

Neutropenia (neutrophil count <0.5 or <1 X 109/L if recent chemotherapy within previous 3 weeks) and sepsis.

Sepsis – temperature >38°C or hypothermic (<36°C) on 2 occasions, at least 30 minutes apart or clinically unwell even if apyrexial. Symptoms may include fever, sweats, chills, rigors, malaise, respiratory rate >20 breaths/minute, tachycardia (>90bpm) or hypotension. Note: patients may appear to be well perfused despite hypotension. *Patients on high dose steroids or severely immunocompromised may not have an increased temperature, but present with symptoms of sepsis.

Septic shock – sepsis induced hypotension requiring inotropic support or hypotension that is unresponsive (within 1 hour) to adequate fluid resuscitation i.e. systolic <90mmHg or reduction >40mmHg from baseline.

Management of immunocompromised patient with fever

An immunocompromised patient with fever should be managed as follows:

  • If neutropenic, treat as per Initial Management of Neutropenic Sepsis in Adults Guidelines.
  • If not neutropenic and the source of the infection is unknown treat as per Initial Management of Neutropenic Sepsis in Adults Guidelines.
  • If not neutropenic and the source of infection has been identified (excluding stem cell transplant patients) then manage as per empirical infection management guidelines based on identified source of infection. Consider additional serious fungal or viral infection. Discuss with appropriate specialist and contact microbiology / infectious diseases unit for advice (see Appendix 6 for contact details).
  • If patient is HIV positive then manage infection as per empirical infection management guidelines based on identified source of infection. Contact infectious diseases consultant on call (see Appendix 6 for contact details).

 

Content last updated April 2019