Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy

^a Fever is defined as a single oral temperature of ≥38.3°C (101°F), or a temperature of ≥38.0°C (100.4°F) sustained over a one-hour period.

^b In the absence of an alternative explanation, clinicians should assume that fever in a patient with neutropenia from cancer therapy is the result of an infection. The initial diagnostic approach should maximize the chances of establishing clinical and microbiologic diagnoses that may affect antibacterial choice and prognosis. A systematic evaluation should include:

• Complete history and physical examination to identify infectious foci.
• Complete blood count with leukocyte differential count, hemoglobin and platelet count; serum electrolytes; serum creatinine and blood urea nitrogen; serum lactate; and liver function tests including total bilirubin, alkaline phosphatase, and transaminases.
• At least two sets of blood cultures from different anatomic sites, including a peripheral site as well as at least one line lumen of a central venous catheter if present, although the Expert Panel recognizes that that some centers may modify this practice and use only peripheral cultures, given the potential for false positive results with blood cultures from the line lumen of a central venous catheter.
• Cultures from other sites such as urine, lower respiratory tract, CSF, stool, or wounds, as clinically indicated.
• Chest imaging study for patients with signs and/or symptoms of lower respiratory tract infection, and consider chest imaging for other patients.