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
...riage to Initial Empirical Antibiotic Ther...
...1. Triage to Initial Empirical Antibacter...
...1. Triage to Initial Empirical Antibacterial...
...is defined as a single oral temperature of...
...tients with an influenza-like illness (sudden...
...stration of empirical antibiotics:...
Identification of Candidates for Outpatient Management
...cation of Candidates for Outpatient Management...
...dentification of Candidates for Ou...
...ification of Candidates for Outpat...
...judgment should be used when selecting cand...
...index or Talcott’s rules are recommended to...
...the setting of a high prevalence of...
...s with febrile neutropenia who are e...
...w-risk outpatients with febrile neutropenia who do...
...with fever and neutropenia who are...
...ith FN who are undergoing outpatien...
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
...le 1. Additional Specific Clinical C...
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 With C...
Table 3. The Talcott’s Classification
...cott’s ClassificationHaving trouble viewi...
Table 4. The Clinical Index of Stable Febrile Neutropenia (CISNE) Includes Six Explanatory Variable Associated with Serious Complicationsa
...inical Index of Stable Febrile Neut...