Neutropenic Fever - CHEMOTHERAPY CYCLE 1
6Cancer patients receiving cytotoxic antineoplastic therapy sufficient to adversely affect myelopoiesis and the developmental integrity of the gastrointestinal mucosa are at risk for invasive infection due to colonizing bacteria and/or fungi that translocate across intestinal mucosal surfaces. Since the magnitude of the neutrophil-mediated component of the inflammatory response may be muted in neutropenic patients [1], a fever may be the earliest and only sign of infection. It is critical to recognize neutropenic fever early and to initiate empiric systemic antibacterial therapy promptly to avoid progression to a sepsis syndrome and possibly death.
Guidelines have been developed for the evaluation and management of fever in neutropenic patients with cancer [2-4]. The recommendations below are generally in keeping with the 2010 Infectious Diseases Society of America (IDSA) guidelines and the 2018 American Society of Clinical Oncology/IDSA guidelines [2,4]. (See 'Society guideline links' below.)
This topic will provide an overview of the concepts related to neutropenic fever, including definitions of fever and neutropenia and categories of risk. The risk assessment and diagnostic approach to patients presenting with neutropenic fever are discussed in detail separately. The management of neutropenic fever syndromes in cancer patients at high and low risk for complications and the prophylaxis of infections in such patients are also discussed in detail separately. Granulocyte transfusions are also reviewed elsewhere. (See "Risk assessment of adults with chemotherapy-induced neutropenia" and "Diagnostic approach to the adult cancer patient with neutropenic fever" and "Treatment of neutropenic fever syndromes in adults with hematologic malignancies and hematopoietic cell transplant recipients (high-risk patients)" and "Treatment and prevention of neutropenic fever syndromes in adult cancer patients at low risk for complications" and "Prophylaxis of infection during chemotherapy-induced neutropenia in high-risk adults" and "Prophylaxis of invasive fungal infections in adults with hematologic malignancies" and "Prophylaxis of invasive fungal infections in adult hematopoietic cell transplant recipients" and "Use of granulocyte colony stimulating factors in adult patients with chemotherapy-induced neutropenia and conditions other than acute leukemia, myelodysplastic syndrome, and hematopoietic cell transplantation" and "Granulocyte transfusions".)