Management of the Neutropenic Patient with Fever

Abstract

Neutrophils provide protection against a wide variety of common and opportunistic bacterial and fungal pathogens. Consequently, the frequency and severity of infections caused by these organisms is increased in patients with neutropenia. At most cancer treatment centers, Gram-positive organisms are isolated more frequently from neutropenic patients with documented bacterial infections than Gram-negative bacilli, although institutional and regional differences occur as do periodic shifts in the spectrum of bacterial infections. Candida spp. and Aspergillus spp. remain the most common fungal pathogens in this setting, although a number of opportunistic fungal pathogens have emerged. The prompt administration of empiric, broad-spectrum, parenteral antibiotics in the hospital when a neutropenic patient becomes febrile is the standard of care. Over the past decade, it has become possible to reliably identify "low-risk" neutropenic patients both in adult and pediatric patient populations. Infection prevention (prophylaxis), infection control, and antimicrobial stewardship are important aspects in the overall management of the febrile neutropenic patient.