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Accentuate the Gram positive: an unusual infection in an oncology patient
  1. Natalie Kemp1,
  2. Tim Malpas1,
  3. Jessica Bate2
  1. 1 Paediatrics, Jersey General Hospital, Saint Helier, Jersey
  2. 2 Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
  1. Correspondence to Dr Tim Malpas, Paediatrics, Jersey General Hospital, Saint Helier JE1 3QS, Jersey; timmalpas{at}

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A 3-year-old boy was diagnosed with Wilms tumour. A central line was inserted and treatment was commenced as per the Children’s Cancer and Leukaemia Group preoperative guidelines for Wilms tumour, following which a nephrectomy was performed. During week 7 of postoperative chemotherapy with vincristine and actinomycin, he developed a fever of 38.5°C at home and was immediately brought to hospital.

Question 1

Which of the following scenarios would cause you to delay administration of broad spectrum antibiotics?

  1. A nurse remeasures his temperature and it is 37.5°C

  2. On clinical assessment he is well and has only minor coryzal symptoms

  3. Neutrophil count 24 hours previously was 1.5×109/L

  4. Blood samples could not be obtained because the central line is difficult to access

  5. None of the above.

He was commenced on intravenous piperacillin with tazobactam. Initial full blood count showed neutrophils to be 1.4×10 …

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  • Contributors All authors contributed to the writing of this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.