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
...nitial Empirical Antibiotic Therapy...
.... Triage to Initial Empirical Antibacterial...
...age to Initial Empirical Antibacterial The...
...ined as a single oral temperature of â...
...influenza-like illness (sudden onset of...
...tration of empirical antibiotics:...
Identification of Candidates for Outpatient Management
...tion of Candidates for Outpatient Management...
...gure 2. Identification of Candidates fo...
...2. Identification of Candidates for Outpat...
...Clinical judgment should be used when sel...
...The MASCC index or Talcott’s rules are recom...
...etting of a high prevalence of ESBL-producing Gra...
...Patients with febrile neutropenia who are elig...
e Low-risk outpatients with febrile neutropeni...
...ith fever and neutropenia who are appropriate can...
...patients with FN who are undergoing out...
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 C...
Table 2. MASCC Scoring System to Identify Patients With Cancer and Febrile Neutropenia at Low Risk of Medical Complicationsa
...C Scoring System to Identify Patients...
Table 3. The Talcott’s Classification
...able 3. The Talcott’s ClassificationHavi...
Table 4. The Clinical Index of Stable Febrile Neutropenia (CISNE) Includes Six Explanatory Variable Associated with Serious Complicationsa
...e Clinical Index of Stable Febrile Neutropenia...