Febrile neutropenia

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Febrile neutropenia is the development of fever, often with other signs of infection, in a patient with neutropenia, an abnormally low number of neutrophil granulocytes (a type of white blood cell) in the blood. The term neutropenic sepsis is also applied, although it tends to be reserved for patients who are more unwell. Fever is actually caused by infection in 50% of cases, and bacteremia (bacteria in the bloodstream) may be present in as many as 20% of all patients with an absolute neutrophil count under 1.0.^[1]

Febrile neutropenia can develop in any form of neutropenia, but is most generally recognized as a complication of chemotherapy when this is myelosuppressive (suppresses the bone marrow from producing blood cells). Generally, patients with febrile neutropenia are treated with empirical antibiotics until the neutrophil count has recovered and the fever has abated; if the neutrophil count does not improve, treatment may need to continue for two weeks or occasionally more. Guidelines issued in 2002 by the Infectious Diseases Society of America recommend the use of particular combinations of antibiotics in specific settings; mild low-risk cases may be treated with a combination of oral co-amoxiclav and ciprofloxacin, while more severe cases require cefalosporins with activity against Pseudomonas aeruginosa (e.g. ceftazidime), or carbapenems (imipenem or meropenem).^[1] A subsequent meta-analysis published in 2006 found that cefepime was associated with more negative outcomes, and that carbapenems (while causing a higher rate of pseudomembranous colitis were the most straightforward in use.^[2]

The Multinational Association for Supportive Care in Cancer (MASCC) Risk Index can be used to identify low-risk patients (score ≥21 points) for serious complications of febrile neutropenia (including death, intensive care unit admission, confusion, cardiac complications, respiratory failure, renal failure, hypotension, bleeding, and other serious medical complications).^[3] The score was developed to select patients for therapeutic strategies that could potentially be more convenient or cost-effective. Prospective studies evaluating the use of the MASCC score to identify patients that can be managed with early oral antibiotics or out-of-hospital are ongoing.^{[citation needed]}