Abstract. This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that. Risk of febrile neutropenia (FN) should be systematically assessed (in consultation with infectious disease specialists as needed), including. Febrile neutropenia (FN) is a serious complication of cancer chemotherapy that The Infectious Diseases Society of America (IDSA), National.

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Guidelines in the Management of Febrile Neutropenia for Clinical Practice

Similarly, effective monotherapies, such as cefepime and carbapenems, are also unlikely to benefit from the empirical addition of vancomycin for persistent fever, and this practice is discouraged. One recent study demonstrated that delaying appropriate antibiotic therapy for P.

Furthermore, the selection of patients who may benefit the most from antimicrobial prophylaxis see Section VI is based upon these criteria for being at high risk, which are derived from clinical trials [ 20—41 ].

The strongest evidence has been for fluoroquinolone prophylaxis [ — ], which has demonstrated an association with reductions in febrile events, documented infections, and bloodstream infections due to gram-positive or gram-negative bacteria [ — ]. Prophylaxis with micafungin or caspofungin is efficacious and well-tolerated for the prevention of candidiasis and invasive aspergillosis in high-risk patients []. Antimicrobial modifications should be based on identified or suspected pathogens if none can be cultured and on available antimicrobial susceptibility data, including local susceptibility and resistance trends.

Imipenem-cilastatin versus sulbactam-cefoperazone plus amikacin in the initial treatment of febrile neutropenic cancer patients.

Hand hygiene, maximal sterile barrier precautions, and cutaneous antisepsis with chlorhexidine during CVC insertion are recommended for all CVC insertions A- – I. Reassess after days of empirical antibiotic therapy. Other herpesvirus infections occur in the post-HSCT setting, including infections due to cytomegalovirus and human herpesvirus – 6. Other oral regimens, including levofloxacin or ciprofloxacin monotherapy or ciprofloxacin plus clindamycin, are less well studied but are commonly used B-III.

Practice Guidelines

In addition to this clinical definition, the MASCC has developed a risk assessment scheme and a well-validated scoring method that can identify subgroups of febrile neutropenic patients with low or high risk of complications and death [ 242—44 ].


Low-risk patients who have initiated IV or oral antibiotics in the hospital may have their treatment approach simplified if they are clinically stable A-I. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. In some patients, catheter removal is not feasible because of thrombocytopenia, the hazards associated with reimplantation during neutropenia, or the absence of other vascular access sites.

Clinical judgment is recommended when determining which patients febile candidates for outpatient management, using clinical criteria or a validated tool such as the Multinational Association of Support Care in Cancer risk index.

However, neutropenia is not a predisposition to reactivation of either virus; thus, prevention strategies for neutropenis 2 herpes viruses are not discussed in this document [ ]. However, as with other hospitalized patients, when contact with body fluids is anticipated, standard barrier precautions should be followed [ ].

Renal and liver function are neutropsnia investigated during the initial assessment for serum creatinine febril, blood urea nitrogen, electrolytes, hepatic transaminase enzymes, and total bilirubin to plan supportive care and appropriate treatment.

Such patients should be initially admitted to the hospital for empirical therapy A-II. Until recently, however, trials have failed to show a survival advantage associated nwutropenia antibiotic prophylaxis, which, when combined with concern regarding the promotion of antibiotic-resistant bacteria and fungal overgrowth, as well as the risk for drug-related adverse effects, has strengthened the argument against routine use [ — ].

The bacterial, viral, and fungal prophylaxis recommendations herein reflect the Panel’s interpretations of clinical trial results. It is crucial to monitor patients for signs and symptoms of infection, which may present as fever, chills, or sweats. Patients with neutropenia, other than HSCT recipients, do not need to be placed into a single-patient room.

For example, although bacteremia with coagulase-negative staphylococci is common among neutropenic patients, nfutropenia pathogen is of low virulence; management often does not require catheter removal and can usually be achieved with vancomycin given through the infected catheter lumen s.


Clinical practice patterns of managing low-risk adult febrile neutropenia during cancer chemotherapy in the USA.

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The choice of empirical antifungal agent depends upon likely fungal pathogens, toxicities, and cost. In addition, earlier detection of invasive fungal infections has led to debate regarding optimal use of empirical or preemptive antifungal therapy, although algorithms are still evolving.

If a patient is being treated for FN with fluoroquinolone prophylaxis, a fluoroquinolone cannot be used as an initial empiric therapy.

With the advent of new strains of influenza, such as the H1N1 pandemic strain, it is important that the most-current available vaccines for each season be given promptly [ ].

Oral antibiotics with early hospital discharge compared with in-patient intravenous antibiotics for low-risk febrile neutropenia in patients with cancer: For management of most patients, the Panel recommends involvement of an infectious diseases specialist knowledgeable about infections of the immunocompromised host.

In a small randomized trial, cooked and noncooked food diets were compared; avoidance of raw fruits and vegetables did not prevent major infection or death [ ]. A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia.

The bacterial pathogens that cause most bloodstream infections in the setting of neutropenia are iddsa in Table 1. High-risk patients require inpatient management with IV broad-spectrum antibiotic therapy that covers P. One meta-analysis demonstrated a protective effect limited to trials that used itraconazole oral solution doses of mg twice a day; however, the oral solution is rarely employed because of poor tolerability [].

The Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the isa in the light of each patient’s individual circumstances.

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