ICU · Infectious Diseases

Neutropenic sepsis (febrile neutropenia)

Also known as Febrile neutropenia · Neutropenic sepsis · Neutropenic fever · Chemotherapy-induced neutropenia · MASCC risk index · Anti-pseudomonal coverage · Neutropenic enterocolitis · Typhlitis

Febrile neutropenia is a potentially life-threatening complication of anticancer chemotherapy. IDSA 2010: treat fever and neutropenia swiftly and broadly for gram-positive and gram-negative pathogens. ASCO/IDSA 2018 (Taplitz) and Flowers 2013: initial empirical antibacterials within 1 hour of triage. SSC 2021: antimicrobials immediately, ideally within 1 h of recognition for possible shock; ≥30 mL/kg crystalloid within the first 3 h. ICU delay of 1 hour in neutropenic severe sepsis associated with OR of death of 10. Critically ill cancer patients: unadjusted mortality ~60% with neutropenia vs ~47% without (gap disappears after severity adjustment). Empiric anti-pseudomonal beta-lactam (pip-taz, anti-pseudomonal cephalosporin, or carbapenem). MASCC ≥21 PPV 91% for low risk. Walsh: caspofungin 33.9% vs L-AmB 33.7% as empirical antifungal. G-CSF is prophylaxis (Kuderer FN RR 0.54; ASCO ~20% FN-risk regimens).

Checked against its sources on 3 Sept 2026