The diagnostic approach to the febrile neutropenic patient: Clinical considerations

Abstract

There are several important factors to be considered by the clinician who is assessing a cancer patient with the presentation of a possible neutropenic fever syndrome. Such considerations can help the clinician to ascertain the likelihood of infection and identify the likelihood that the patient will develop serious medical complications as a function of the febrile neutropenic episode. A high clinical index of suspicion in the context of cancer patients who are receiving systemic cytotoxic therapy and who present with a febrile illness between day 10 and 14 of the current chemotherapy cycle is an important part of the initial assessment. An understanding that initial signs and symptoms of infection may be muted by the relative lack of circulating inflammatory cells. Inappropriate initial management remains associated with unacceptably high excess morbidity and mortality. A rapid systematic assessment is critical for the choice of empirical antibacterial therapy, the formulation and venue for the administration of that therapy, and timeliness of the administration of treatment. Standards have been developed for these assessments and interventions and have been recommended as important measures of system performance.