Reassessment of the high-risk patient with persistent neutropenic fever after four days of empiric therapy

ANC: absolute neutrophil count; CT: computed tomography; MRI: magnetic resonance imaging.

* We consider patients to be high-risk if they have either of the following characteristics: neutropenia (ANC <500 cells/microL following cytotoxic chemotherapy) anticipated to last >7 days OR significant comorbid conditions. It should be noted that in the Infectious Diseases Society of America guidelines, an ANC ≤100 cells/microL is used as the cutoff for high-risk neutropenia.

¶ Fever in a neutropenic patient is defined as a single temperature >38.3°C (101°F) or a sustained temperature >38.0°C (100.4°F) for >1 hour.

Δ Limited data to support recommendation.

◊ Spectrum activity and adverse effect profiles vary among antifungals. An echinocandin is often selected for patients without specific concern for infection with mold due to its favorable adverse effect profile. Refer to UpToDate text for detail.

Adapted with permission from: 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):e56-93. Copyright © 2011 Oxford University Press. https://www.idsociety.org/practice-guideline/neutropenic-patients-with-cancer/ (Accessed on March 29, 2023).

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Reassessment of the high-risk patient with persistent neutropenic fever after four days of empiric therapy