Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression

Publication Date: September 4, 2018

Key Points

Key Points

Patients undergoing cytotoxic chemotherapy and hematopoietic stem cell transplant are at risk for infection, particularly during the period of neutropenia.

The risk of infection increases with the depth and duration of neutropenia, with the greatest risk occurring in patients who experience profound, prolonged neutropenia after chemotherapy, which is most likely to occur in the period prior to engraftment during hematopoietic cell transplantation and following induction chemotherapy for acute leukemia.

Fever can be an important indicator and is often the only sign or symptom of infection although clinicians should also be mindful that severely or profoundly neutropenic patients may present with suspected infection in an afebrile state, or even hypothermic.

Prevention and appropriate management of febrile neutropenia (FN) is important because the rate of major complications (e.g. hypotension, acute renal, respiratory or heart failure) in the context of FN is approximately 25–30%, and mortality up to 11%. In the setting of severe sepsis or septic shock the hospital mortality rate may be as high as 50%.

1. Carmona-Bayonas A, Jimenez-Fonseca P, Virizuela Echaburu J, et al: Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the Clinical Index of Stable Febrile Neutropenia in a prospective cohort of patients from the FINITE study. J Clin Oncol 33:465-71, 2015.

2. Kuderer NM, Dale DC, Crawford J, et al: Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 106:2258-66, 2006.

3. Legrand M, Max A, Peigne V, et al: Survival in neutropenic patients with severe sepsis or septic shock. Crit Care Med 40:43-9, 2012.


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