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
...Triage to Initial Empirica...
.... Triage to Initial Empirical Antiba...
...Figure 1. Triage to Initi...
...Fever is defined as a single oral...
...nts with an influenza-like illness (sudden ons...
...of empirical antibiotics: Assessment sh...
Identification of Candidates for Outpatient Management
...dentification of Candidates for Outpatient Ma...
...Figure 2. Identification...
...judgment should be used when selecting c...
...ndex or Talcott’s rules are recommended to...
...g of a high prevalence of ESBL-producing Gr...
...h febrile neutropenia who are eligible for dischar...
...w-risk outpatients with febrile neutr...
...ith fever and neutropenia who are ap...
...or patients with FN who are undergoing ou...
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
...Additional Specific Clinical Criteriaa That...
Table 2. MASCC Scoring System to Identify Patients With Cancer and Febrile Neutropenia at Low Risk of Medical Complicationsa
...coring System to Identify Patients With Canc...
Table 3. The Talcott’s Classification
...e 3. The Talcott’s Classification...
Table 4. The Clinical Index of Stable Febrile Neutropenia (CISNE) Includes Six Explanatory Variable Associated with Serious Complicationsa
...nical Index of Stable Febrile Neutropenia (CISNE)...