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
...Initial Empirical Antibiotic Th...
.... Triage to Initial Empirical Antib...
...e 1. Triage to Initial Empirical Antibacterial T...
...ever is defined as a single oral temperatu...
Patients with an influenza-like illness (sudde...
...ion of empirical antibiotics: Assessme...
Identification of Candidates for Outpatient Management
...of Candidates for Outpatient Mana...
...2. Identification of Candidates for Outpatient Ma...
...e 2. Identification of Candidates for Outpatient...
...judgment should be used when selecting...
...The MASCC index or Talcott’s rules ar...
...ng of a high prevalence of ESBL-producing Gr...
...ients with febrile neutropenia who are elig...
...k outpatients with febrile neutropenia who do not...
...s with fever and neutropenia who are appropriate...
...r patients with FN who are undergoing...
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
...tional Specific Clinical Criteriaa That May Be...
Table 2. MASCC Scoring System to Identify Patients With Cancer and Febrile Neutropenia at Low Risk of Medical Complicationsa
...able 2. MASCC Scoring System to Identify Pa...
Table 3. The Talcott’s Classification
...3. The Talcott’s ClassificationHaving trouble v...
Table 4. The Clinical Index of Stable Febrile Neutropenia (CISNE) Includes Six Explanatory Variable Associated with Serious Complicationsa
...Clinical Index of Stable Febrile Neutropenia (C...