Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy
Key Points
Key Points
- Neutropenia, a decrease in the absolute neutrophil count (ANC), occurs frequently in recipients of chemotherapy.
- The greatest risk of infection occurs 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 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.
- The rate of major complications (e.g., hypotension, acute renal, respiratory or heart failure) in the context of neutropenic fever syndromes is approximately 25-30%, and mortality up to 11%.
- In the setting of severe sepsis or septic shock, hospital mortality may be as high as 50%.
Triage to Initial Empirical Antibiotic Therapy
...itial Empirical Antibiotic Thera...
...1. Triage to Initial Empirical Anti...
...e to Initial Empirical Antibacterial The...
...Fever is defined as a single oral temperatur...
...s with an influenza-like illness (sudde...
...tion of empirical antibiotics: A...
Identification of Candidates for Outpatient Management
...fication of Candidates for Outpatient Management...
...tification of Candidates for Outpati...
...2. Identification of Candidates fo...
...linical judgment should be used when...
...e MASCC index or Talcott’s rules are recommende...
...ing of a high prevalence of ESBL-producing Gram...
...Patients with febrile neutropenia who are...
...k outpatients with febrile neutropenia...
...with fever and neutropenia who are appropriate...
...ith FN who are undergoing outpatient antibiotic tr...
Table 1. Additional Specific Clinical Criteriaa That May Be Used to Exclude Oncology Patients Who Have Fever and Neutropenia from Initial Outpatient Care Even with a MASCC Score ≥21
...e 1. Additional Specific Clinical Criteria...
Table 2. MASCC Scoring System to Identify Patients With Cancer and Febrile Neutropenia at Low Risk of Medical Complicationsa
...MASCC Scoring System to Identify Patients With...
Table 3. The Talcott’s Classification
...e Talcott’s ClassificationHaving troubl...
Table 4. The Clinical Index of Stable Febrile Neutropenia (CISNE) Includes Six Explanatory Variable Associated with Serious Complicationsa
...inical Index of Stable Febrile Neut...