Guidelines
Fever & Neutropenia in a Cancer Patient

Fever & Neutropenia in a Cancer Patient

Definitions

The risk of infection associated with neutropenia is related to the severity and duration of neutropenia.

  • Single oral temperature of ≥38.3°C OR
  • A temperature of ≥38°C for 1 hr or more

Patients may be hypothermic or afebrile with suspected infection

  • Absolute neutrophil count (ANC) of ≤0.5 x 10⁹/L (≤500 cells/mm³) OR
  • ANC of ≤1 x 10⁹/L, with a predicted decrease to ≤0.5 x 10⁹/L within 48 hours

Diagnostics

Obtain cultures prior to antibiotics

Treatment

  • Start antibiotics urgently to improve outcomes (e.g. within 1-2 hours)
  • If a focus is identified, refer to specific treatment guidelines for any additional coverage required (e.g., azithromycin for pneumonia)

Consult Hematology for use of G-CSF

Follow Up

Additional Information

Guideline originally sourced from Markham Stouffville Hospital and adapted by Joseph Brant Hospital

  • Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011;52(4):e56-e93.

  • Taplitz RA, Kennedy EB, Flowers CR. Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update Summary. J Oncol Pract. 2018;14(4):250-255.

  • de Naurois J, Novitzky-Basso I, Gill MJ, et al. Management of febrile neutropenia: ESMO Clinical Practice Guidelines. Ann Oncol. 2010;21 Suppl 5:v252-v256.

  • The Johns Hopkins University (2020) John Hopkins ABX Guide (1.27) [Mobile App] Retrieved from: www.hopkinsguides.com

  • Antimicrobial Therapy Inc (2020) The Sanford Guide (4.2) [Mobile App] Retrieved from: www.sanfordguide.com/

Approved: June 2020