Abstract. This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that. Risk of febrile neutropenia (FN) should be systematically assessed (in consultation with infectious disease specialists as needed), including. Febrile neutropenia (FN) is a serious complication of cancer chemotherapy that The Infectious Diseases Society of America (IDSA), National.

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Serious infections due to S.

Guidelines in the Management of Febrile Neutropenia for Clinical Practice

Detection of bloodstream infections in adults: The searches were limited to neutropfnia studies and to specific study design or publication type: Some hazards related to use of these gram-positive agents include the emergence of linezolid-resistant Enterocococcus species in neutropenic patients receiving the drug, marrow-suppression with linezolid, and severe arthralgias with quinupristin-dalfopristin [ — ].

These include pre-engraftment allogeneic HSCT recipients receiving nsutropenia conditioning regimens, some autologous HSCT recipients unsupported by hematopoietic growth factors, and patients undergoing intensive induction chemotherapy regimens for AML with severe oral and gastrointestinal mucositis [].

In previously published prospective, randomized trials involving febrile neutropenic populations, an association between mortality and cefepime was not identified [ 98 ].

Adapted from [ 43 ]. Low-risk patients are those with neutropenia enutropenia to resolve within 7 days and no active medical co-morbidity, as well as stable and adequate hepatic function and renal function. HSCT allograft transplant recipients should receive prophylaxis through the neutropenic period and beyond, because a survival advantage has been demonstrated for patients who continue antifungal prophylaxis long after engraftment, for at least 75 days after transplant [ ], or until cessation of immunosuppressive therapy [ ].

Although it is attractive, preemptive antifungal therapy currently remains largely experimental and is not standard of practice. Therefore, patients with profound, persistent myelosuppression and no identifiable source of infection should continue antibiotic therapy until there is idsw of marrow recovery.

Randomized trial comparing oral ciprofloxacin plus penicillin V with amikacin plus carbenicillin or ceftazidime for empirical treatment of febrile neutropenic cancer patients.

In various studies of prospective serial serum galactomannan testing in high-risk patients, neitropenia has ranged widely among different patient populations and has depended upon the optical density cutoff used to define a positive test [ — ].

Since the s, studies have demonstrated reductions in the frequency of febrile episodes and in the prevalence of some documented infections among patients who receive prophylactic fegrile during the early afebrile period of neutropenia [ — ].

IDSA GUIDELINES Bundle (free trial)

Ffbrile incidence of leukemia and mortality from sepsis febrole patients with severe congenital neutropenia receiving long-term G-CSF therapy. All members of the Panel complied with the IDSA policy on conflicts of interest, which requires disclosure of any financial or other interest that might be construed as constituting an actual, potential, or apparent conflict.


Less common organisms include Bacillus speciesCorynebacterium JK, enterococci including VRErapidly growing mycobacteria, and non-fermentative gram-negative bacilli [ ]. Several studies have indicated that, if the antibiotic course is finished but the patient remains neutropenic and afebrile, resuming fluoroquinolone prophylaxis is safe [ 67 ]. However, as with other hospitalized patients, when contact with body fluids is anticipated, standard barrier precautions should be followed [ ].

The question of when to initiate and discontinue antibacterial chemoprophylaxis has not been systematically studied. There is limited value in sending a stool specimen for bacterial pathogen cultures or for ova and parasite examination for most patients treated in US hospitals unless there has been recent travel to or residence in areas of endemicity.

Suspicion of vancomycin-resistant enterococcus calls for the addition of linezolid or daptomycin. Patients who develop neutropenic enterocolitis should be treated with an expanded broad-spectrum regimen, although the most efficacious regimen is unknown. In general, cebrile patient who does not strictly fulfill criteria for being at low risk should be treated according to guidelines for high-risk patients.

For documented infections, the duration of antibiotic therapy should be appropriate for effective eradication of the identified infection.

Accordingly, algorithmic approaches to fever and neutropenia, infection prophylaxis, diagnosis, and treatment have been established during the past 40 years, guided and modified by clinical evidence febrlie experience over time.

IDSA GUIDELINES Bundle (free trial) – Fever and Neutropenia

In cases in which the catheter must be retained, it is prudent to prolong the antimicrobial IV systemic therapy, particularly in the case of S. The high cost and need for parenteral administration are limitations of these agents. In the febrile neutropenic patient, substantially better outcomes can be expected with prompt initiation of the critical management pathways discussed in this document [ 17 ].

Of note, hemodialysis, hemolysis, serum turbidity, hyperlipidemia, visible bilirubin, use of blood products including immunoglobulin and albumin, bacteremia, and the specimen’s exposure to gauze may confound interpretation of the test. The epidemiology of candidemia has changed with the broad use of fluconazole prophylaxis, which has led to an increase in Candida species eg, C.

Determinants of vancomycin resistance and mortality rates in enterococcal bacteremia. The outcome difference was due to more Candida infections occurring in the preemptive group, which did not receive antifungal prophylaxis [ — ]. Those who remain febrile after 4—7 days of broad-spectrum antibiotics but are clinically stable, have no clinical or chest and sinus computed tomography CT signs of fungal infection, have negative serologic assay results for evidence of invasive fungal infection, and have no recovery of fungi such as Candida or Aspergillus species from any body site may have antifungal agents withheld B-II.


An important exception, as noted above, is for low-risk outpatients who are being treated with empirical oral or IV therapy. Accordingly, many experts do not recommend fluoroquinolone prophylaxis for neutropenic autologous HSCT recipients. The strongest evidence has been for fluoroquinolone prophylaxis [ — ], which has demonstrated an association with reductions in febrile events, documented infections, and bloodstream infections due to gram-positive or gram-negative bacteria [ — ].

Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Additional factors that increase the risk of complications for patients with FN following cancer chemotherapy are summarized in Table 2. Febrilr addition, high-risk patients may have clinically relevant comorbidities such as hypotension, pneumonia, new onset of abdominal pain, renal or hepatic insufficiency, or neurological changes.

In the neutropenic patient with cancer, collection of blood culture sets from all CVC lumens if presentas well as 1 set from a peripheral vein, is advocated during the initial evaluation of fever. They are not recommended for low-risk patients. As noted above, ciprofloxacin monotherapy is not an adequate therapy for febrile neutropenic patients because of its weak activity against gram-positive organisms, especially viridans streptococci [ 1221— ].

With preemptive treatment, antifungal therapy is given only when evidence of invasive infection is suggested by one of these tests. Persistent fever in an otherwise asymptomatic and hemodynamically stable patient is not a neutroopenia for undirected antibiotic additions or changes.

Prepared luncheon meats should be avoided. Vancomycin-resistant Staphylococcus aureus in the absence of vancomycin exposure. The FDA study, which included both trial data and patient-level data controlled for mortality-related risk factors, found no statistically significant increase in day mortality associated with cefepime use RR, 1. VRE colonization is an important risk factor for subsequent invasive disease [ 15 ].

What is the role of antiviral prophylaxis and how are respiratory viruses diagnosed and managed in the neutropenic patient? One recent study demonstrated that delaying appropriate antibiotic therapy for P. A multicenter, double-blind, placebo-controlled trial comparing piperacillin-tazobactam with and without amikacin as empiric therapy for febrile neutropenia.