Febrile neutropenia - Revision history

Aidan: /* Resources */

2022-04-06T18:56:24Z

Resources

← Older revision		Revision as of 18:56, 6 April 2022
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	== Resources ==		== Resources ==

	* [~~http~~://www.~~qxmd~~.com/~~calculate~~-~~online/hematology/~~febrile-neutropenia~~-mascc~~ MASCC risk calculator]		* [https://www.mdcalc.com/mascc-risk-index-febrile-neutropenia MASCC risk calculator]

	== Further Reading ==		== Further Reading ==

Aidan: Text replacement - "== Presentation" to "== Clinical Manifestations"

2020-08-02T12:26:11Z

Text replacement - "== Presentation" to "== Clinical Manifestations"

← Older revision		Revision as of 12:26, 2 August 2020
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	** Profound neutropenia: ANC < 0.1×10^9^/L		** Profound neutropenia: ANC < 0.1×10^9^/L

	== ~~Presentation~~ ==		== Clinical Manifestations ==

	* Fever		* Fever

Aidan: Text replacement - "Category:Immunocompromised patients" to "Category:Immunocompromised hosts"

2020-02-28T16:39:59Z

Text replacement - "Category:Immunocompromised patients" to "Category:Immunocompromised hosts"

← Older revision		Revision as of 16:39, 28 February 2020
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	[[Category:Fever syndromes]]		[[Category:Fever syndromes]]
	[[Category:Immunocompromised ~~patients~~]]		[[Category:Immunocompromised hosts]]

Aidan: Text replacement - "amoxicillin/clavulanic acid" to "amoxicillin-clavulanic acid"

2019-10-29T15:15:28Z

Text replacement - "amoxicillin/clavulanic acid" to "amoxicillin-clavulanic acid"

← Older revision		Revision as of 15:15, 29 October 2019
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	** [[Anidulafungin]] if renal or hepatic dysfunction		** [[Anidulafungin]] if renal or hepatic dysfunction
	* In high-risk patients, can consider adding GCSF (Neupogen/Filgrastim)		* In high-risk patients, can consider adding GCSF (Neupogen/Filgrastim)
	* In some low-risk patients, can step down to [[amoxicillin/clavulanic acid]] AND [[ciprofloxacin]] 750		* In some low-risk patients, can step down to [[amoxicillin-clavulanic acid]] AND [[ciprofloxacin]] 750
	** Expected duration of severe neutropenia ≤7 days, AND		** Expected duration of severe neutropenia ≤7 days, AND
	** No comorbidities or significant hepatic or renal dysfunction		** No comorbidities or significant hepatic or renal dysfunction

Aidan: /* Management */ added links

2019-09-11T14:25:53Z

Management: added links

← Older revision		Revision as of 14:25, 11 September 2019
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	== Management ==		== Management ==

	* In general, broad-spectrum antimicrobials until fever resolved x48h AND neutrophils > 0.5 AND minimum course of 5-7 days, then consider stepping down to treat underlying infection only		* In general, broad-spectrum antimicrobials until '''fever resolved x48h AND neutrophils > 0.5 AND minimum course of 5-7 days''', then consider stepping down to treat underlying infection only
	* Empiric antibiotic choice depends on site but should include ~~Pseudomonal~~ coverage		* Empiric antibiotic choice depends on site but should include pseudomonal coverage
		⚫	** [[Piptazo]] 4.5g q8h, [[Ceftazidime]] 2g q8h, [[Ciprofloxacin]] 400 q12h and [[gentamicin]] 5-7mg/kg q24h, [[Meropenem]] 1g q8h
	** Piptazo 4.5g q8h
	** Ceftazidime 2g q8h
⚫	** Ciprofloxacin 400 q12h and gentamicin 5-7mg/kg q24h
	** Meropenem 1g q8h
	* Consider adding other agents empirically if concern for:		* Consider adding other agents empirically if concern for:
	** MRSA or SSTI or severe mucositis or septic shock: vancomycin 15mg/kg q12h, reassessed at 48h		** [[MRSA]] or SSTI or severe [[mucositis]] or septic shock: vancomycin 15mg/kg q12h, reassessed at 48h
	** Typhlitis: ensure adequate anaerobic coverage, may need to add metronidazole 500mg q12h		** [[Typhlitis]]: ensure adequate anaerobic coverage, may need to add metronidazole 500mg q12h
	** VRE: linezolid or daptomycin		** [[VRE]]: linezolid or daptomycin
	** ESBL: carbapenem		** [[ESBL]]: carbapenem
	** KPC: polymixin-colistin or tigecycline		** [[KPC]]: polymixin-colistin or tigecycline
	* If still febrile and neutropenic for 4 to 7 days despite antibiotics, add antifungal (especially if not on prophylaxis)		* If still febrile and neutropenic for 4 to 7 days despite antibiotics, add antifungal (especially if not on prophylaxis)
	** Caspofungin 70mg then 50mg daily		** [[Caspofungin]] 70mg then 50mg daily
	** Liposomal amphotericin B 3mg/kg daily		** Liposomal [[amphotericin]] B 3mg/kg daily
	** Anidulafungin if renal or hepatic dysfunction		** [[Anidulafungin]] if renal or hepatic dysfunction
	* In high-risk patients, can consider adding GCSF (Neupogen/Filgrastim)		* In high-risk patients, can consider adding GCSF (Neupogen/Filgrastim)
	* In some low-risk patients, can step down to ~~amox~~/~~clav~~ AND ~~cipro~~ 750		* In some low-risk patients, can step down to [[amoxicillin/clavulanic acid]] AND [[ciprofloxacin]] 750
	** Expected duration of severe neutropenia ≤7 days, AND		** Expected duration of severe neutropenia ≤7 days, AND
	** No comorbidities or significant hepatic or renal dysfunction		** No comorbidities or significant hepatic or renal dysfunction

Aidan at 15:11, 17 August 2019

2019-08-17T15:11:06Z

← Older revision		Revision as of 15:11, 17 August 2019
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	= Definition =		== Definition ==

	* Fever: temperature ≥38.3°C once, or ≥38ºC sustained for at least one hour		* Fever: temperature ≥38.3°C once, or ≥38ºC sustained for at least one hour
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	** Profound neutropenia: ANC < 0.1×10^9^/L		** Profound neutropenia: ANC < 0.1×10^9^/L

	= Presentation =		== Presentation ==

	* Fever		* Fever
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	** Anus		** Anus

	= Different Diagnosis =		== Different Diagnosis ==

	* No focus is identified and no cultures isolated in about half of cases		* No focus is identified and no cultures isolated in about half of cases
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	** Fungi: Candida (bloodstream), Aspergillus (heme malignancies)		** Fungi: Candida (bloodstream), Aspergillus (heme malignancies)

	= Epidemiology =		== Epidemiology ==

	* 80% of patients receiving chemotherapy have at least one episode of febrile neutropenia		* 80% of patients receiving chemotherapy have at least one episode of febrile neutropenia
	* Genetic predisposition like mannose-binding lectin deficiency doubles the duration of fever		* Genetic predisposition like mannose-binding lectin deficiency doubles the duration of fever

	= Investigations =		== Investigations ==

	* Blood cultures from all lines, including central lines, repeated at least every 72h if it continues		* Blood cultures from all lines, including central lines, repeated at least every 72h if it continues
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	* If ongoing fevers, consider CT chest		* If ongoing fevers, consider CT chest

	= Management =		== Management ==

	* In general, broad-spectrum antimicrobials until fever resolved x48h AND neutrophils > 0.5 AND minimum course of 5-7 days, then consider stepping down to treat underlying infection only		* In general, broad-spectrum antimicrobials until fever resolved x48h AND neutrophils > 0.5 AND minimum course of 5-7 days, then consider stepping down to treat underlying infection only
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	* Monitor for myeloid reconstitution syndrome (similar to IRIS) while neutrophils are recovering		* Monitor for myeloid reconstitution syndrome (similar to IRIS) while neutrophils are recovering

	= Resources =		== Resources ==

	* [http://www.qxmd.com/calculate-online/hematology/febrile-neutropenia-mascc MASCC risk calculator]		* [http://www.qxmd.com/calculate-online/hematology/febrile-neutropenia-mascc MASCC risk calculator]

	= Further Reading =		== Further Reading ==

	* [https://doi.org/10.1093/cid/cir073 IDSA 2011]		* [https://doi.org/10.1093/cid/cir073 IDSA 2011]

Aidan at 01:41, 15 August 2019

2019-08-15T01:41:23Z

← Older revision		Revision as of 01:41, 15 August 2019
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	* [https://doi.org/10.1093/cid/cir073 IDSA 2011]		* [https://doi.org/10.1093/cid/cir073 IDSA 2011]

	[[Category:~~Febrile~~ syndromes]]		[[Category:Fever syndromes]]
	[[Category:Immunocompromised patients]]		[[Category:Immunocompromised patients]]

Aidan at 01:40, 15 August 2019

2019-08-15T01:40:38Z

← Older revision		Revision as of 01:40, 15 August 2019
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		⚫	= Definition =
	= Febrile neutropenia / neutropenic fever =

⚫	== Definition ==

	* Fever: temperature ≥38.3°C once, or ≥38ºC sustained for at least one hour		* Fever: temperature ≥38.3°C once, or ≥38ºC sustained for at least one hour
Line 8:		Line 6:
	** Profound neutropenia: ANC < 0.1×10^9^/L		** Profound neutropenia: ANC < 0.1×10^9^/L

	== Presentation ==		= Presentation =

	* Fever		* Fever
Line 17:		Line 15:
	** Anus		** Anus

	== Different Diagnosis ==		= Different Diagnosis =

	* No focus is identified and no cultures isolated in about half of cases		* No focus is identified and no cultures isolated in about half of cases
Line 26:		Line 24:
	** Fungi: Candida (bloodstream), Aspergillus (heme malignancies)		** Fungi: Candida (bloodstream), Aspergillus (heme malignancies)

	== Epidemiology ==		= Epidemiology =

	* 80% of patients receiving chemotherapy have at least one episode of febrile neutropenia		* 80% of patients receiving chemotherapy have at least one episode of febrile neutropenia
	* Genetic predisposition like mannose-binding lectin deficiency doubles the duration of fever		* Genetic predisposition like mannose-binding lectin deficiency doubles the duration of fever

	== Investigations ==		= Investigations =

	* Blood cultures from all lines, including central lines, repeated at least every 72h if it continues		* Blood cultures from all lines, including central lines, repeated at least every 72h if it continues
Line 40:		Line 38:
	* If ongoing fevers, consider CT chest		* If ongoing fevers, consider CT chest

	== Management ==		= Management =

	* In general, broad-spectrum antimicrobials until fever resolved x48h AND neutrophils > 0.5 AND minimum course of 5-7 days, then consider stepping down to treat underlying infection only		* In general, broad-spectrum antimicrobials until fever resolved x48h AND neutrophils > 0.5 AND minimum course of 5-7 days, then consider stepping down to treat underlying infection only
Line 65:		Line 63:
	* Monitor for myeloid reconstitution syndrome (similar to IRIS) while neutrophils are recovering		* Monitor for myeloid reconstitution syndrome (similar to IRIS) while neutrophils are recovering

	== Resources ==		= Resources =

	* [http://www.qxmd.com/calculate-online/hematology/febrile-neutropenia-mascc MASCC risk calculator]		* [http://www.qxmd.com/calculate-online/hematology/febrile-neutropenia-mascc MASCC risk calculator]

	== Further Reading ==		= Further Reading =

	* [https://doi.org/10.1093/cid/cir073 IDSA 2011]		* [https://doi.org/10.1093/cid/cir073 IDSA 2011]

			[[Category:Febrile syndromes]]
			[[Category:Immunocompromised patients]]

Aidan: Aidan moved page Febrile to Febrile neutropenia without leaving a redirect

2019-08-15T01:39:45Z

Aidan moved page Febrile to Febrile neutropenia without leaving a redirect

← Older revision		Revision as of 01:39, 15 August 2019
(No difference)

Maintenance script: Imported from text file

2019-08-11T17:58:17Z

Imported from text file

New page

= Febrile neutropenia / neutropenic fever =

== Definition ==

* Fever: temperature ≥38.3°C once, or ≥38ºC sustained for at least one hour
* Neutropenia: absolute neutrophil count (ANC) < 1×10^9^/L
** Severe neutropenia: ANC < 0.5×10^9^/L, or expected to decrease below 0.5×10^9^/L within the next 48 hours
** Profound neutropenia: ANC < 0.1×10^9^/L

== Presentation ==

* Fever
* Signs/symptoms of any infection:
** Oropharynx
** Chest
** Skin
** Anus

== Different Diagnosis ==

* No focus is identified and no cultures isolated in about half of cases
** When a focus is identified: respiratory > bloodstream > urinary > SSTI/GI/other
* Cultures
** Gram-negative: E. coli > Pseudomonas > Klebsiella > others
** Gram-positive: Coag-neg Staph > Staph aureus > Enterococcus > other
** Fungi: Candida (bloodstream), Aspergillus (heme malignancies)

== Epidemiology ==

* 80% of patients receiving chemotherapy have at least one episode of febrile neutropenia
* Genetic predisposition like mannose-binding lectin deficiency doubles the duration of fever

== Investigations ==

* Blood cultures from all lines, including central lines, repeated at least every 72h if it continues
* Urinalysis +/- urine culture
* CXR regardless of symptoms
* Nasopharyngeal swab for respiratory viruses
* Stool for C.diff, if appropriate
* If ongoing fevers, consider CT chest

== Management ==

* In general, broad-spectrum antimicrobials until fever resolved x48h AND neutrophils > 0.5 AND minimum course of 5-7 days, then consider stepping down to treat underlying infection only
* Empiric antibiotic choice depends on site but should include Pseudomonal coverage
** Piptazo 4.5g q8h
** Ceftazidime 2g q8h
** Ciprofloxacin 400 q12h and gentamicin 5-7mg/kg q24h
** Meropenem 1g q8h
* Consider adding other agents empirically if concern for:
** MRSA or SSTI or severe mucositis or septic shock: vancomycin 15mg/kg q12h, reassessed at 48h
** Typhlitis: ensure adequate anaerobic coverage, may need to add metronidazole 500mg q12h
** VRE: linezolid or daptomycin
** ESBL: carbapenem
** KPC: polymixin-colistin or tigecycline
* If still febrile and neutropenic for 4 to 7 days despite antibiotics, add antifungal (especially if not on prophylaxis)
** Caspofungin 70mg then 50mg daily
** Liposomal amphotericin B 3mg/kg daily
** Anidulafungin if renal or hepatic dysfunction
* In high-risk patients, can consider adding GCSF (Neupogen/Filgrastim)
* In some low-risk patients, can step down to amox/clav AND cipro 750
** Expected duration of severe neutropenia ≤7 days, AND
** No comorbidities or significant hepatic or renal dysfunction
** Mostly, these patients are receiving chemotherapy for solid tumours
* Monitor for myeloid reconstitution syndrome (similar to IRIS) while neutrophils are recovering

== Resources ==

* [http://www.qxmd.com/calculate-online/hematology/febrile-neutropenia-mascc MASCC risk calculator]

== Further Reading ==

* [https://doi.org/10.1093/cid/cir073 IDSA 2011]