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
...iage to Initial Empirical Antibiotic Thera...
Figure 1. Triage to Initial Empirical An...
...re 1. Triage to Initial Empirical Antibacterial T...
a Fever is defined as a single oral t...
...an influenza-like illness (sudden onset of a res...
c Administration of empirical anti...
Identification of Candidates for Outpatient Management
...ion of Candidates for Outpatient Manageme...
...gure 2. Identification of Candidates for Outpatie...
...entification of Candidates for Outpatient M...
...judgment should be used when selecting candid...
...ex or Talcott’s rules are recommended too...
...tting of a high prevalence of ESBL-pro...
...Patients with febrile neutropenia wh...
...k outpatients with febrile neutropenia who do...
...In patients with fever and neutropenia who are...
...ents with FN who are undergoing outpatient a...
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
...itional Specific Clinical Criteriaa That May...
Table 2. MASCC Scoring System to Identify Patients With Cancer and Febrile Neutropenia at Low Risk of Medical Complicationsa
...CC Scoring System to Identify Patients W...
Table 3. The Talcott’s Classification
...e Talcott’s ClassificationHaving trouble view...
Table 4. The Clinical Index of Stable Febrile Neutropenia (CISNE) Includes Six Explanatory Variable Associated with Serious Complicationsa
...linical Index of Stable Febrile Neutropenia (CISNE...