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Updated: Dec 22 2021

Neutropenic Fever

  • 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
  • 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
            • 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
  • Prognosis
    • Delayed or inadequate empiric antibiotics leads to worse outcomes
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