A 61-year-old man attends the emergency department nine days after chemotherapy for non-Hodgkin lymphoma. He has developed rigors and increasing

Question

A 61-year-old man attends the emergency department nine days after chemotherapy for non-Hodgkin lymphoma. He has developed rigors and increasing weakness. His temperature is 37.2°C, heart rate 132/min, blood pressure 82/46 mmHg and venous lactate 3.6 mmol/L. He has a tunnelled central venous catheter, but its exit site is unremarkable. Blood cultures have been taken; the full blood count is pending. He has no antibiotic allergy, known resistant infection or history of heart failure. Intravenous access and monitoring are in place. Admission and urgent senior review are being arranged. Which immediate treatment strategy is most appropriate?

Accepted Answer

Give a 250 mL intravenous crystalloid bolus and intravenous piperacillin–tazobactam now.

Answer

Give a 250 mL intravenous crystalloid bolus now; start intravenous piperacillin–tazobactam when the neutrophil count returns.

Answer

Give a 250 mL intravenous crystalloid bolus and intravenous piperacillin–tazobactam plus gentamicin now.

Answer

Give a 250 mL intravenous crystalloid bolus and intravenous piperacillin–tazobactam plus vancomycin now.

Answer

Give a 250 mL intravenous crystalloid bolus and intravenous ceftriaxone now.

Suspected neutropenic sepsis with circulatory compromise — MRCEM SBA MCQ