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 Therapy
...age to Initial Empirical Antibacterial The...
.... Triage to Initial Empirical Antibacterial Thera...
...ned as a single oral temperature of ≥...
...with an influenza-like illness (sudden ons...
...tration of empirical antibiotics: As...
Identification of Candidates for Outpatient Management
...tification of Candidates for Outpatient Manag...
...Identification of Candidates for Outpatient...
...tification of Candidates for Outpatient Managemen...
...judgment should be used when selecting candidates...
...SCC index or Talcott’s rules are recomm...
...he setting of a high prevalence of ESB...
...ients with febrile neutropenia who are eligible f...
...risk outpatients with febrile neutropenia who do...
...ients with fever and neutropenia w...
...patients with FN who are undergoi...
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
...dditional Specific Clinical Criteria...
Table 2. MASCC Scoring System to Identify Patients With Cancer and Febrile Neutropenia at Low Risk of Medical Complicationsa
Table 2. MASCC Scoring System to Identify Pa...
Table 3. The Talcott’s Classification
...3. The Talcott’s ClassificationHaving troubl...
Table 4. The Clinical Index of Stable Febrile Neutropenia (CISNE) Includes Six Explanatory Variable Associated with Serious Complicationsa
...Clinical Index of Stable Febrile Neutropenia (...