Neutropenic fever

Neutropenic fever in cancer patients is a common but life-threatening medical condition with high mortality. Unfortunately, patients with neutropenic fever may not show definitive signs or symptoms of infection because of the chemotherapy-induced myelosuppression and compromised immune system. Recognizing neutropenic fever and starting empirical antibiotics promptly are key to the management of cancer patients with this complication. Upon the neutropenic fever patient’s arrival to the emergency department, management should begin with thorough history taking, physical examination, laboratory assessment work, and imaging studies to stratify the patient’s risk for complications and death. Along with starting empirical antibiotics to cover most virulent organisms such as gram-negative bacteria as soon as possible, through risk stratification is another key point in management. According to the risk status of the patient, the physician may decide whether to admit the patient or discharge home with oral antibiotics. This chapter describes the basic pathophysiology of neutropenic fever and initial assessment to identify potential infection. Prompt administration of empirical antibiotics is emphasized, as well, but, more importantly, risk stratification of the patient and appropriate disposition of the patient are also introduced.