- Definition: temperature > 38.3 or 2 readings of >38 (1 hour apart) AND an absolute neutrophil count <0.5 x 10^9/L or <1.0 x 10^9/L with a predicted nadir of <0.5 within 48 hours
- Patients without neutrophils may present with little to no signs of inflammation - a detailed assessment to look for a source is needed
- In addition to the usual culprits check for mucositis, oral thrush or vesicular lesions, GI infection including perianal abscess (no rectal!), and examine the indwelling venous catheter
- While no single antibiotic has been shown to be superior, hospitalized patients should be initiated on IV antibiotics with broad spectrum and anti-pseudomonal coverage (ie. piperacillin/tazobactam or imipenem). Vancomycin is only added upfront if there is suspicion for a gram positive infection, the patient is high risk for MRSA, or is hemodynamically unstable
- Neutropenic patients are at risk of invasive fungal infections (ie. aspergillus). After day 4-7 of persistent fevers, investigating for and potentially starting treatment for a fungal infection may be warranted
- Check out a pocketcard summary of the IDSA guidelines for febrile neutropenia in cancer patients
Very nice article!
ReplyDeleteTOSHIBA PVM-375AT
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