The definition that matters is a single oral temperature of 38.3 degrees or more, or 38.0 degrees or more sustained over an hour, in a patient with an absolute neutrophil count under 0.5 x 10^9/L or expected to fall below it. That is not a threshold for investigation. It is the diagnosis, and the clock starts at the door.
The target is antibiotics within one hour. In practice the hour is lost in predictable places: waiting for the count before treating, waiting for the second temperature reading, waiting for cultures to be taken by someone else, and waiting for a line to be accessed. Cultures should be taken - peripheral and from each lumen of any central line - but they are taken while the antibiotic is being drawn up, not before it is prescribed.
Two things to check that are often missed. Patients on corticosteroids or paracetamol may not mount a fever at all, so unexplained hypotension, rigors, confusion or simply feeling unwell in a neutropenic patient carries the same urgency. And the last chemotherapy date tells you where in the nadir they are - ask for it, because a patient at day 10 of a myelosuppressive regimen who feels unwell is neutropenic until the count says otherwise.
- Treat within one hour; do not wait for the neutrophil count to come back
- Take peripheral and each-lumen central line cultures while the antibiotic is being prepared
- Ask the date of the last chemotherapy dose - it locates the patient in the nadir
- Suspect sepsis without fever in patients on steroids or recent paracetamol
- Give the patient a written date-stamped alert card if your unit does not already
Why it matters
The hour is almost always lost to waiting for confirmation that the diagnosis has already been made.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for oncology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free