Approach to Patient with Fever and Neutropenia - Flowchart

Approach to Patient with Fever and Neutropenia - Flowchart

Approach to Patient with Fever and Neutropenia - Flowchart Fever and Neutropenia Fever and Neutropenia

«Flowchart»

Fever and neutropenia

Fever and neutropenia

Fever and neutropenia

Low risk

Low risk

Low risk

High risk

High risk

High risk

Broad spectrum oral antibiotic therapy (e.g., fluoroquinolone^b +/- amoxicillin clavulanate)

Broad spectrum oral antibiotic therapy (e.g., fluoroquinolone^b +/- amoxicillin clavulanate)

Broad spectrum oral antibiotic therapy (e.g., fluoroquinolone^b +/- amoxicillin clavulanate)

^b b

Continue antibiotics 7 days

Continue antibiotics 7 days

Continue antibiotics 7 days

Work-up and treat for invasive fungal infection

Work-up and treat for invasive fungal infection

Work-up and treat for invasive fungal infection

Continue antibiotics until afebrile and PMN recovery

Continue antibiotics until afebrile and PMN recovery

Continue antibiotics until afebrile and PMN recovery

End

End

End

Antimicrobial alteration as determined by clinical course

Antimicrobial alteration as determined by clinical course

Antimicrobial alteration as determined by clinical course

Intravenous antipseudomonal beta-lactam,^ccephalosporin,^dor carbapenem,^e
+/- aminoglycoside^f
+/- antistaphylococcal agent^g

Intravenous antipseudomonal beta-lactam,^ccephalosporin,^dor carbapenem,^e
+/- aminoglycoside^f
+/- antistaphylococcal agent^g

Intravenous antipseudomonal beta-lactam,^ccephalosporin,^dor carbapenem,^e
+/- aminoglycoside^f
+/- antistaphylococcal agent^g

^c c ^d d ^e e
^f f
^g g

^a Hypotension, altered mental status, neurologic changes, respiratory failure, abdominal pain, hemorrhage, cardiac compromise or new arrhythmia, catheter tunnel infection, extensive cellulitis, acute renal or liver failure

^a Hypotension, altered mental status, neurologic changes, respiratory failure, abdominal pain, hemorrhage, cardiac compromise or new arrhythmia, catheter tunnel infection, extensive cellulitis, acute renal or liver failure

^a Hypotension, altered mental status, neurologic changes, respiratory failure, abdominal pain, hemorrhage, cardiac compromise or new arrhythmia, catheter tunnel infection, extensive cellulitis, acute renal or liver failure

^a

^b Institution sensitivity dependent, ciprofloxacin, levofloxacin, moxifloxacin

^b Institution sensitivity dependent, ciprofloxacin, levofloxacin, moxifloxacin

^b Institution sensitivity dependent, ciprofloxacin, levofloxacin, moxifloxacin

^b

^c Drug selection and dosing institution-specific: Piperacillin tazobactam, ticarcillin/clavulanate

^c Drug selection and dosing institution-specific: Piperacillin tazobactam, ticarcillin/clavulanate

^c Drug selection and dosing institution-specific: Piperacillin tazobactam, ticarcillin/clavulanate

^c

^d Drug selection and dosing institution-specific: Ceftazidime

^d Drug selection and dosing institution-specific: Ceftazidime

^d Drug selection and dosing institution-specific: Ceftazidime

^d

^eimipenem, cefepime/cilastatin, meropenem, doripenem

^eimipenem, cefepime/cilastatin, meropenem, doripenem

^eimipenem, cefepime/cilastatin, meropenem, doripenem

^e

^f Gentamicin, tobramycin, or amikacin

^f Gentamicin, tobramycin, or amikacin

^f Gentamicin, tobramycin, or amikacin

^f

^g Drug selection and institution institution-specific: Vancomycin, linezolid, daptomycin, ceftaroline

^g Drug selection and institution institution-specific: Vancomycin, linezolid, daptomycin, ceftaroline

^g Drug selection and institution institution-specific: Vancomycin, linezolid, daptomycin, ceftaroline

^g

Re-evaluate therapy after 72 hr

Re-evaluate therapy after 72 hr

Re-evaluate therapy after 72 hr

Afebrile, PMNs recovering

Afebrile, PMNs recovering

Afebrile

Febrile, PMNs recovering

Febrile, PMNs recovering

Febrile

Febrile, PMNs not recovering

Febrile, PMNs not recovering

Febrile, PMNs

Risk assessment

Risk assessment

Risk assessment

<7 days neutropenia
Solid tumor
Mucositis absent or mild
Lack of comorbidities^a

<7 days neutropenia
Solid tumor
Mucositis absent or mild
Lack of comorbidities^a

<7 days neutropenia
Solid tumor
Mucositis absent or mild
Lack of comorbidities^a ^a a <7 days neutropenia

≥7 days neutropenia
Hematological cancer or HSCT
Severe mucositis
Comorbidities^apresent

≥7 days neutropenia
Hematological cancer or HSCT
Severe mucositis
Comorbidities^apresent

≥7 days neutropenia ≥
Hematological cancer or HSCT
Severe mucositis
Comorbidities^apresent ^a a >=7 days neutropenia