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
