7/30/2019 @ HNELHD CG 12 16 Sepsis Fact Sheet
1/2
FACT SHEETIssued: August 2012
Immunology & Infectious DiseasesMicrobiology, Hunter Area
Pathology
ANTIBIOTICS
Use one of the following options after assessing
patient for a history of penicillin allergy:
Piperacillin/tazobactam 4+0.5 g IV 8-hourly(preferred first line
option)
Ceftazidime 2g IV 8-hourly (option for patientwith non-immediate
penicillin allergy)
Vancomycin should NOT be used presumptively in
febrile neutropenic patients unless the patient is in
shock, is known to be colonised with methicillin-
resistant Staphylococcus aureus (MRSA) or has
clinical evidence of a catheter-related infection in a
unit with a higher incidence of MRSA infection (ie.
Calvary Mater Hospital).
If any of these criteria are met, ADD vancomycin to
the above regimen:
Vancomycin 1.5 g IV, 12-hourly (adjust initial dosage
for renal function and monitor blood concentrations,
see Therapeutic Guidelines Edition 14, appendix 2.3;
slow infusion required).
Patients with an immediate type penicillin-allergy
Consult supervising Haematologist, Oncologist or
Infectious Diseases Physician on-call via telephone
49213000.
Immediate hypersensitivity is characterised by the
development of urticaria, angioedema,
bronchospasm or anaphylaxis (with objectively
demonstrated hypotension, hypoxia or tryptase
elevation) within one to two hours of drugadministration.
REFERENCES
Blood culture collection procedure (CEC)
Clinical Excellence Commission, Adult Sepsis Pathway
Therapeutic Guidelines: Antibiotic, Edition 14
Hunter New England Sepsis Adult First Dose
Empirical Antibiotic Guideline
Emergency Department
management of adults receiving
chemotherapy with symptoms or
signs of potential sepsis
CRITERION
Any patient who is receiving chemotherapy,
whether known to be neutropenic or not, who
presents with fever, chills, rigors or unwell.
PROCESS
1. Triage the patient as category 22. Follow theCEC Adult Sepsis
Pathway
(overleaf)
3. Perform a thorough history andexamination and consider
decisions based
on presumed cause of presentation
4. Perform investigations (below) PRIOR toadministration of
antibiotics. Do NOT delay
treatment while awaiting results
5. Commence recommended empiricantibiotic(s) (below). Benchmark
for
administration of antibiotics is less than 1
hour from triage
6. Discuss the patient with the supervisingHaematologist or
Oncologist as soon as
possible
ROUTINE INVESTIGATIONS
Blood cultures: two sets collected from separate
peripheral venipunctures (20 mL each set in an
adult, 3-5mLs in a child). Collection from a pre-
existing intravascular device should only be done
as a last resort or after direction by supervising
Haematologist or Oncologist and must follow
correct aseptic practice.
FBC, calcium, electrolytes and LFTs
Mid-stream urine
http://proxy9.use.hcn.com.au/tgc/abg/7971.htmhttp://www.cec.health.nsw.gov.au/__documents/programs/sepsis/cec-sepsis-program_adult-blood-culture-sampling-guide_v2-2012.pdfhttp://www.cec.health.nsw.gov.au/__documents/programs/sepsis/cec-sepsis-program_adult-blood-culture-sampling-guide_v2-2012.pdfhttp://www.cec.health.nsw.gov.au/__documents/programs/sepsis/sepsis_pathway_final_3_may_2011_adult.pdfhttp://www.cec.health.nsw.gov.au/__documents/programs/sepsis/sepsis_pathway_final_3_may_2011_adult.pdfhttp://etg.hcn.com.au/http://etg.hcn.com.au/http://intranet.hne.health.nsw.gov.au/__data/assets/pdf_file/0010/67744/HNELHD_CG_12_16_Sepsis_First_Dose.pdfhttp://intranet.hne.health.nsw.gov.au/__data/assets/pdf_file/0010/67744/HNELHD_CG_12_16_Sepsis_First_Dose.pdfhttp://intranet.hne.health.nsw.gov.au/__data/assets/pdf_file/0010/67744/HNELHD_CG_12_16_Sepsis_First_Dose.pdfhttp://www.cec.health.nsw.gov.au/__documents/programs/sepsis/sepsis_pathway_final_3_may_2011_adult.pdfhttp://www.cec.health.nsw.gov.au/__documents/programs/sepsis/sepsis_pathway_final_3_may_2011_adult.pdfhttp://www.cec.health.nsw.gov.au/__documents/programs/sepsis/sepsis_pathway_final_3_may_2011_adult.pdfhttp://www.cec.health.nsw.gov.au/__documents/programs/sepsis/sepsis_pathway_final_3_may_2011_adult.pdfhttp://intranet.hne.health.nsw.gov.au/__data/assets/pdf_file/0010/67744/HNELHD_CG_12_16_Sepsis_First_Dose.pdfhttp://intranet.hne.health.nsw.gov.au/__data/assets/pdf_file/0010/67744/HNELHD_CG_12_16_Sepsis_First_Dose.pdfhttp://etg.hcn.com.au/http://www.cec.health.nsw.gov.au/__documents/programs/sepsis/sepsis_pathway_final_3_may_2011_adult.pdfhttp://www.cec.health.nsw.gov.au/__documents/programs/sepsis/cec-sepsis-program_adult-blood-culture-sampling-guide_v2-2012.pdfhttp://proxy9.use.hcn.com.au/tgc/abg/7971.htm
