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Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy

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Key Points ➤ Neutropenia, a decrease in the absolute neutrophil count (ANC), occurs frequently in recipients of chemotherapy. ➤ The greatest risk of infection occurs in patients who experience profound, prolonged neutropenia after chemotherapy, which is most likely to occur in the period prior to engraftment during hematopoietic cell transplantation and following induction chemotherapy for acute leukemia. ➤ Fever is often the only sign or symptom of infection, although clinicians should also be mindful that severely or profoundly neutropenic patients may present with suspected infection in an afebrile state, or even hypothermic. ➤ The rate of major complications (e.g., hypotension, acute renal, respiratory or heart failure) in the context of neutropenic fever syndromes is approximately 25- 30%, and mortality up to 11%. • In the setting of severe sepsis or septic shock, hospital mortality may be as high as 50%. Figure 1. Triage to Initial Empirical Antibacterial Therapy Patients with fever seeking emergency medical care within 6 weeks of receiving chemotherapy • Assume bacterial infection • Document fever a and draw pretreatment blood samples Triage Conduct systematic assessment to maximize chances of establishing clinical and microbiologic diagnoses that may affect antibacterial choice and prognosis b Administer empirical antibiotics c Within 15 minutes of triage Within one hour of triage Triage to Initial Empirical Antibiotic Therapy

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