Guidelines
Fever and Neutropenia

Fever and Neutropenia

Notes

Fever with neutropenia is a medical emergency

Site Applicability:

  • Applicable in all BC Children’s Hospital areas where neutropenic oncology patients are cared for

Patient Applicability: This is applicable to:

  • Patients on antineoplastic agents
  • Allogeneic stem cell transplant patients within 6 months of transplantation or still receiving immunosuppressive agents, and
  • Patients who have completed cancer therapy but still have a central venous line (CVL) in situ
  • Children with fever and neutropenia require urgent triage, evaluation and treatment. Blood cultures must be collected and antimicrobials must be administered STAT, prior to patient transfer to any other area, within one hour of patient presentation or fever if inpatient
  • The clinical pathway below should be followed and the recommendations for empiric antibiotic use should be implemented. Subsequent treatment will also be dictated by the hospital’s infection diseases team and the antibiotic’s sensitivity profile
  • The treating pediatric oncologist or (oncologist on call after hours) must be notified when a child on active oncology treatment develops a fever while neutropenic
  • Fever in non-neutropenic patients requires blood cultures
  • If patient is clinically well and there are no focal infections requiring treatment, empiric therapy is not required

Fever:

  • In the oncology population, fever is defined as greater than or equal to 38.5ºC oral or temporal
    • If unable to obtain oral or temporal temperature, axillary temperature greater than or equal to 38ºC is considered a fever
    • There may be different fever guidelines in patient specific protocols and research studies

Neutropenia:

  • Neutropenia is defined as an absolute neutrophil count (ANC) < 0.5x10⁹ cells/L
    • ANC is the sum of neutrophils and bands

Fever and Neutropenia Clinical Algorithm

Algorithm for use when:

  • Physician-on-call or clinic receives call from parent: child has fever OR
  • Child arrives in Emergency Department with history of fever (38.0º AX or 38.5º PO/Temporal)

More Information

  1. Lehrnbecher T, Robinson P, Fisher B, Alexander S, Ammann RA, Beauchemin M, et al. Guideline for the Management of Fever and Neutropenia in Children With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update. J Clin Oncol. 2017 Jun 20;35(18):2082–94.
  2. Manji A, Beyene J, Dupuis LL, Phillips R, Lehrnbecher T, Sung L. Outpatient and oral antibiotic management of low-risk febrile neutropenia are effective in children—a systematic review of prospective trials. Support Care Cancer. 2012 Jun;20(6):1135–45.
  3. Robinson PD, Lehrnbecher T, Phillips R, Dupuis LL, Sung L. Strategies for Empiric Management of Pediatric Fever and Neutropenia in Patients With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: A Systematic Review of Randomized Trials. J Clin Oncol. 2016 Jun 10;34(17):2054–60.
  4. Sung L, Manji A, Beyene J, Dupuis LL, Alexander S, Phillips R, et al. Fluoroquinolones in Children With Fever and Neutropenia: A Systematic Review of Prospective Trials. Pediatr Infect Dis J. 2012 May;31(5):431–5.

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