Neutropenic Fever

Don’t be fooled. The patient with no immune system deserves significant respect and requires our vigilance.- Sean M. Fox MD

Neutropenic Fever
Neutropenic Fever

image by: Rhoda Baer - NIH

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Neutropenic Fever Syndrome

The management’s holy grail is antibiotics, but with such diverse and elite targets, where do you shoot? Let us try and oversimplify this: If the bugs are coming from our gut, they better be gram-negative rods (Pseudomonas aeruginosa!) That was so very true back in the day. Now, with the introduction to long-term indwelling central venous catheters, the empiric antibiotics to cover P. aeruginosa, and other gram negatives (Ciprofloxacin)– Staphylococcus epidermidis is winning the race. The gram-negatives are catching up; 60:40 is the score currently.

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 Neutropenic Fever Syndrome

Neutropenia is one of the two common instances when a rectal temperature is wrong; the other is thrombocytopenic patients. Oral temperature is adequate; make sure they don’t have oral mucositis that can falsely increase the reading in the patient’s thermometer and your head at the same time.

10 Best Papers of 2021, Peripartum Cardiomyopathy, Crashing Asthmatic, Febrile Neutropenia, Anaphylaxis update

Scores such as the Multinational Association for Supportive Care in Cancer (MASCC) (solid and hematologic malignancies) and Clinical Index of Stable Febrile Neutropenia (CISNE) (solid malignancies) can assist in patient disposition

Clinical Index of Stable Febrile Neutropenia (CISNE)

Identifies febrile neutropenia patients at low risk of serious complications.

MASCC Risk Index for Febrile Neutropenia

Identifies patients at low risk for poor outcome with febrile neutropenia..

Rebel EM

Identify low risk patients and send them home with PO antibiotics and close oncology follow-up in conjunction with your oncologist.

WikEM

AVOID rectal temp or digital rectal exam.

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