SHM's Clinical Quick Talks-Febrile Neutropenia

Pdf Summary

Febrile neutropenia is defined as an absolute neutrophil count (ANC) of less than 1000 cells/microliter with a fever. Severe neutropenia is an ANC less than 500, while profound neutropenia is an ANC less than 100. It is most commonly caused by unknown factors, but bacterial, viral, and fungal infections can also be responsible. The most common bacteria associated with febrile neutropenia are staphylococcus, streptococcus, and enterococcus species. Gram-negative bacteria can cause more severe infections. Febrile neutropenia is a common complication for patients with cancer or those undergoing chemotherapy, and fever may be the only sign of an underlying infection. Evaluation involves a detailed history, physical examination, and laboratory tests such as blood cultures, urinalysis, and imaging studies. Risk stratification scores, such as MASCC and CISNE, can help determine the risk of complications. Treatment depends on the risk level, with low-risk patients receiving oral antibiotics and high-risk patients being admitted to the hospital for intravenous antibiotics within an hour. Antifungal coverage may be added in cases of prolonged neutropenia. Prognosis is mostly determined by the timing of antibiotic administration, with early administration leading to better outcomes. Poor prognostic signs include prolonged and profound neutropenia, older age, uncontrolled primary disease, pneumonia, sepsis syndrome, invasive fungal infection, and hospitalization at the time of fever development.

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Jenna Guma, Kathryn Haroldson

Keywords

febrile neutropenia

absolute neutrophil count

bacterial infections

viral infections

fungal infections

risk stratification scores

oral antibiotics

intravenous antibiotics

prognosis

antibiotic administration