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
...e to Initial Empirical Antibiotic Therapy...
...Triage to Initial Empirical Antibacterial Ther...
Figure 1. Triage to Initial Empirica...
...defined as a single oral temperature...
...ients with an influenza-like illness (sud...
...tion of empirical antibiotics: Assessment...
Identification of Candidates for Outpatient Management
...ication of Candidates for Outpatient Managemen...
...fication of Candidates for Outpatie...
...tification of Candidates for Outpatient Manage...
...linical judgment should be used when select...
...index or Talcott’s rules are recommended tools...
...etting of a high prevalence of ESBL...
...atients with febrile neutropenia who are el...
...Low-risk outpatients with febrile neutropeni...
...In patients with fever and neutropenia who a...
...or patients with FN who are undergoing outpat...
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
...ditional Specific Clinical Criteriaa...
Table 2. MASCC Scoring System to Identify Patients With Cancer and Febrile Neutropenia at Low Risk of Medical Complicationsa
...e 2. MASCC Scoring System to Identify Patient...
Table 3. The Talcott’s Classification
...le 3. The Talcott’s Classificatio...
Table 4. The Clinical Index of Stable Febrile Neutropenia (CISNE) Includes Six Explanatory Variable Associated with Serious Complicationsa
...The Clinical Index of Stable Febrile Neutropenia...