EM · Immunocompromised host and febrile neutropenia

Immunocompromised host and febrile neutropenia

Also known as Febrile neutropenia · Neutropenic sepsis · Neutropenic fever · Fever in the immunocompromised host

Febrile neutropenia is the oncological emergency defined by an absolute neutrophil count below 0.5 × 10⁹ per litre together with a single oral temperature of 38.3 degrees or higher (or two readings 38.0 degrees or higher an hour apart) in a patient on cytotoxic chemotherapy, with a haematological malignancy, or after stem-cell transplant. It is treated as a time-critical sepsis equivalent: blood cultures first, then empirical broad-spectrum intravenous antibiotic within one hour — piperacillin-tazobactam 4.5 g IV, ceftazidime 2 g IV, meropenem 1 g IV or cefepime 2 g IV; add vancomycin 1.5 g IV for line infection or MRSA; add aciclovir 10 mg/kg IV for HSV or VZV; add caspofungin for suspected fungal infection. The MASCC risk index stratifies the high-risk patient (admitted, intravenous) from the low-risk (may be discharged on oral ciprofloxacin). The differential is tumour lysis syndrome, the transfusion reaction and drug fever. ACEM-primary, globally tagged.