Neutropenic Fever

Single oral temperature of ≥101ºF (38.3ºC) or a temperature ≥100.4ºF (38.0ºC) sustained over a 1-hour period, with ANC <500 cells/mm³ or an ANC that is expected to decrease to <500 cell/mm³ during the next 48 hours

Diagnostics to Consider

  • Procalcitonin

  • CBC

  • BMP

  • Blood cultures x2 sites

  • MRSA Nasal Swab for PCR

Empiric Treatment Recommendations - Select All Applicable Factors

Clinical indications for coverage of ESBL-producing bacteria:

  • Documentation of prior infections or colonization with ESBL-producing organisms in past 12 months OR

  • Receipt of ≥2 courses of beta-lactam/fluoroquinolone antibiotics (pip-tazo, cefepime, levofloxacin, etc) in past 90 days

Note: Receipt of fluoroquinolone prophylaxis or as a single course is not an indicator for ESBL risk

Clinical indications for additional Gram-positive coverage:

  • Suspected catheter-related infection, OR

  • Probable skin and soft tissue infection, OR

  • Hemodynamic instability, OR

  • Preliminary culture positive for Gram-positive cocci

Clinical indications for aspergillosis coverage:

≥1 of:

  • Unexplained fever >96 hours despite broad-spectrum antibiotics, OR

  • Sinus CT suggestive of fungal infection, OR

  • Recovery of fungus from any site

AND ≥1 of:

  • Chest or sinus CT with macronodules ± halo sign, OR

  • History of invasive aspergillosis, OR

  • Patients undergoing intensive chemotherapy for AML/MDS, OR

  • HSCT recipients with anticipated prolonged neutropenic periods of at least 14 days

Clinical indications for fungal coverage:

  • Unexplained fever >96 hours despite broad-spectrum antibiotics, OR

  • Sinus CT suggestive of fungal infection, OR

  • Recovery of fungus from any site