Title
Use of Antimicrobial Agents in Neutropenic Patients with Cancer
Authoring Organization
Publication Month/Year
February 15, 2011
Last Updated Month/Year
October 10, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
Fever during chemotherapy-induced neutropenia may be the only indication of a severe underlying infection, because signs and symptoms of inflammation typically are attenuated. Physicians must be keenly aware of the infection risks, diagnostic methods, and antimicrobial therapies required for management of febrile patients through the neutropenic period. Accordingly, algorithmic approaches to fever and neutropenia, infection prophylaxis, diagnosis, and treatment have been established during the past 40 years, guided and modified by clinical evidence and experience over time.
The Infectious Diseases Society of America Fever and Neutropenia Guideline aims to provide a rational summation of these evolving algorithms. Summarized below are the recommendations made in the 2010 guideline update. A detailed description of the methods, background, and evidence summaries that support each of the recommendations can be found in the full text of the guideline.
Target Patient Population
Neutropenic Patients with Cancer
PICO Questions
What is the role of risk assessment and what distinguishes high-risk and low-risk patients with fever and neutropenia?
What cultures should be collected and what specific tests should be performed during the initial assessment?
In febrile patients with neutropenia, what empirical antibiotic therapy is appropriate and in what setting?
When and how should antimicrobials be modified during the course of fever and neutropenia?
How long should empirical antibiotic therapy be given?
When should antibiotic prophylaxis be given and with what agents?
What is the role of empirical antifungal therapy and what antifungals should be used?
When should antifungal prophylaxis or preemptive therapy be given and with what agents?
What is the role of antiviral prophylaxis and how are respiratory viruses diagnosed and managed in the neutropenic patient?
What is the role of hematopoietic growth factors (G-CSF or GM-CSF) in managing fever and neutropenia?
How are catheter-related infections diagnosed and managed in neutropenic patients?
What environmental precautions should be taken when managing febrile neutropenic patients?
Inclusion Criteria
Male, Female, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Hospital
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Assessment and screening, Treatment, Management, Prevention
Diseases/Conditions (MeSH)
D064147 - Febrile Neutropenia, D005334 - Fever, D009503 - Neutropenia
Keywords
neutropenia, neutropenic fever, Fever and Neutropenia
Source Citation
Alison G. Freifeld, Eric J. Bow, Kent A. Sepkowitz, Michael J. Boeckh, James I. Ito, Craig A. Mullen, Issam I. Raad, Kenneth V. Rolston, Jo-Anne H. Young, John R. Wingard, Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 52, Issue 4, 15 February 2011, Pages e56–e93, https://doi.org/10.1093/cid/cir073