ABSTRACT
This chapter presents a case study of a 27-year-old man who is receiving bleomycin, etoposide, cisplatin (BEP) chemotherapy for testicular cancer presents to the Emergency Department with feeling generally unwell and a self-reported fever. Any patient receiving chemotherapy and presenting with a fever should be assumed to have neutropaenic sepsis until proven otherwise. The mainstay of treating neutropaenic sepsis is prompt antibiotic therapy, with international guidelines recommending initiation within 60 minutes of presentation. Lower-risk patients may be treated with oral antibiotics either as an in- or outpatient, whereas higher-risk patients require intravenous therapy as an inpatient. In this patient, the presence of hypotension and cool peripheries point to a high-risk individual requiring inpatient hospitalisation. Antibiotic choice is governed by local guidelines and microbiology resistance patterns, but typically broad-spectrum agents to cover Gram-positive and -negative organisms such as a β-lactam antibiotic in combination with an aminoglycoside may be used, with addition of other agents in specific circumstances.
