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 at most 500 cells per microlitre together with a single oral temperature of 38.3 degrees or higher (or above 38.0 maintained over one hour) in a patient on cytotoxic chemotherapy, with a haematological malignancy, or after transplant. It is treated as a time-critical sepsis equivalent: blood cultures first, then empirical broad-spectrum intravenous antibiotic within one hour of triage — an anti-pseudomonal beta-lactam; add vancomycin or teicoplanin only where MRSA cover is indicated; add caspofungin for persistent fever despite broad-spectrum cover. 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.

Checked against its sources on 13 Oct 2026