Many cancer pts are treated with myelotoxic agents. When peripheral blood granulocyte counts are <1000/µL, the risk of infection is substantially increased (48 infections/100 pts). A neutropenic pt who develops a fever (>38°C [100.4°F]) should undergo physical examination with special attention to skin lesions, mucous membranes, IV catheter sites, and perirectal area. Two sets of blood cultures from different sites should be drawn and a CXR performed, and any additional tests should be guided by findings from the history and physical examination. Any fluid collections should be tapped, and urine and/or fluids should be examined under the microscope for evidence of infection.
Treatment: Fever and Neutropenia After cultures are obtained, all pts should receive IV broad-spectrum antibiotics (e.g., ceftazidime, 1 g q8h). If an obvious infectious site is found, the antibiotic regimen is designed to cover organisms that may cause the infection. Usually therapy should be started with an agent or agents that cover both gram-positive and -negative organisms. If the fever resolves, treatment should continue until neutropenia resolves. Persistence of febrile neutropenia after 7 days should lead to addition of amphotericin B (or another broad-spectrum antifungal agent like posaconazole) to the antibiotic regimen. |
Section 2. Medical Emergencies