title: Can mortality of cancer patients with fever and neutropenia be improved?
abstract: OBJECTIVE
  Neutropenic fever is the most common infective complication in patients receiving cytotoxic chemotherapy, and may result in severe sepsis, septic shock and mortality. Advancements in approaches to empiric antimicrobial therapy and prophylaxis have resulted in improved outcomes. Mortality may, however, still be as high as 50% in high-risk cancer populations. The objective of this review is to summarize factors associated with reduced mortality in patients with neutropenic fever, highlighting components of clinical care with potential for inclusion in quality improvement programs.
  
  
  RESULTS
  Risks for mortality are multifactorial, and include patient, disease and treatment-related factors. Historically, guidelines for management of neutropenic fever have focused upon antimicrobial therapy. There is, however, a recognized need for early identification of sepsis to enable timely administration of antibiotic therapy and for this to be integrated with a whole of systems approach within healthcare facilities. Use of Systemic Inflammatory Response Syndrome criteria is beneficial, but validation is required in neutropenic fever populations.
  
  
  CONCLUSIONS
  In the context of emerging and increasing infections because of antimicrobial-resistant bacteria in patients with neutropenic fever, quality improvement initiatives to reduce mortality must encompass antimicrobial stewardship, early detection of sepsis, and use of valid tools for clinical assessment. C-reactive protein and procalcitonin hold potential for inclusion into clinical pathways for management of neutropenic fever.
authors.affiliation: aDepartment of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre bVictorian Infectious Diseases Service, Royal Melbourne Hospital at the Doherty Institute cDepartment of Medicine, University of Melbourne, Victoria, Australia.
authors.forename: Karin A
authors.initials: KA
authors.lastname: Thursky
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Worth
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D000935:Antifungal Agents / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D017410:Practice Guidelines as Topic; D011498:Protein Precursors / Q000097:blood; D058996:Quality Improvement; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000970:Antineoplastic Agents; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide