Snapshot A 68-year-old woman presents to the emergency department due to fatigue, malaise, and a subjective fever. Her symptoms began approximately 1 week ago. Medical history is significant for small cell lung cancer recently treated with doxorubicin plus cyclophosphamide and etoposide. Her temperature is 102°F (38.9°C) and blood pressure is 100/80 mmHg. A complete blood count with differential is remarkable for an absolute neutrophil count of 320 cells/mm3. She is admitted to the hospital and administered intravenous cefepime. Introduction Definition a single fever of ≥ 101°F (38.3°C) in a patient with an absolute neutrophil count (ANC) < 500 cells/mm3 a sustained fever of ≥ 100.4°F (38°C) in a patient with an ANC of < 500 cells/mm3 Epidemiology incidence commonly seen in patients receiving cytotoxic chemotherapy Pathophysiology chemotherapy impairs host immunity, predisposing the patient to infection Prognosis delayed or inadequate empiric antibiotics leads to worse outcomes Presentation Symptoms/physical exam fever tachycardia tachypnea Studies Initial testing includes complete blood count (CBC) with differential complete metabolic panel blood cultures urine culture culture of sites concerning for infection Other studies chest radiography in patients with respiratory findings a CT scan of the chest is typically ordered if chest radiography is unrevealing Treatment Medical high-risk patients (requires hospitalization) intravenous empiric antibiotics that cover for Pseudomonas aeruginosa medications cefepime piperacillin-tazobactam imipenem-cilastatin low-risk patients (can be treated as an outpatient) or patients with neutropenia without a fever oral empiric antibiotics medications oral ciprofloxacin levofloxacin amoxicillin-clavulanate Complications Sepsis syndrome Death
QUESTIONS 1 of 2 1 2 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.ID.13.120) A 13-year-old male is admitted to the hospital for treatment of acute lymphoblastic leukemia. During his hospital course, he develops a fever of 39.0 degrees Celsius. A CBC demonstrates a leukocyte count of <500 /mm^3. Which of the following is the most appropriate initial management of this patient? QID: 106215 Type & Select Correct Answer 1 Granulocyte colony-stimulating factor (G-CSF) 32% (27/85) 2 IV ceftazidime 45% (38/85) 3 Oral doxycycline 0% (0/85) 4 Oral ciprofloxacin and amoxicillin/clavulanic acid 8% (7/85) 5 Strict quarantine and hand-washing 14% (12/85) M 7 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic