title: Management of chemotherapy-induced neutropenic fever.
abstract: Fever occurs at high rates in patients with chemotherapy-induced neutropenia and is considered an oncologic emergency. Numerous algorithms have been developed to guide treatment decisions. Prompt care and the initiation of empiric antibiotic therapy are critically important universal aspects of these treatment-decision schemata. Fever may be the only sign of infection, as in patients with cancer who are undergoing chemotherapy, the immune response is attenuated. In the majority of cases, no etiology for neutropenic fever is uncovered; nonetheless, a thorough workup is essential. The workup allows practitioners to risk stratify patients as being at low or high risk for infectious complications so that appropriate care can be administered. Although it is important to note that there are management algorithms to follow, every patient may present and respond differently. We generally start with broad-spectrum monotherapy for Gram-negative bacteria and then consider whether Gram-positive or antifungal coverage is necessary based on the clinical picture, including factors such as duration and degree of neutropenia. It is important for all practitioners to understand how to care for patients with neutropenic fever because it is a common and treatable condition.
authors: Tisch Cancer Insititute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. aarti.bhardwaj@mountsinai.org
authors: Aarti S
authors: AS
authors: Bhardwaj
authors: Shyamala C
authors: SC
authors: Navada
mesh_terms: D000553:Ambulatory Care / Q000592:standards; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D062905:Central Venous Catheters / Q000009:adverse effects / Q000382:microbiology; D003115:Colony-Stimulating Factors / Q000592:standards / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D005334:Fever / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects; D008826:Microbial Sensitivity Tests; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D009503:Neutropenia / Q000139:chemically induced* / Q000188:drug therapy / Q000382:microbiology; D010343:Patient Admission / Q000592:standards; D018570:Risk Assessment / Q000379:methods
chemical_list: D000890:Anti-Infective Agents; D000935:Antifungal Agents; D000970:Antineoplastic Agents; D000998:Antiviral Agents; D003115:Colony-Stimulating Factors