Febrile neutropenic patient:

Neutropenia is defined as neutrophil count <500. In a case where one is expecting the counts to fall rapidly, counts between 500-1000 also are considered neutropenic. Highest risk is when <100.

Commonest organisms are

Gram negative bacilli including E. coli, Klebsiella pneumoniae and Pseudomonas.

Gram positive organisms are likely too if patient has an indwelling catheter (Coag negative staph, betqa hemolytic strep and Staph aureus)

In those who have had steroids or long term antibiotics, suspect fungal infection (Candida)

Diagnostic considerations include 2 Blood cultures - one from the periphery and the other from a catheter site if present.

If there is a discharge at the catheter exit site, please make sure you culture that.

Routine workup like urine culture, Chest X-ray and aspiration of suspected site of infection is recommended.

Empiric antibiotic initiation is recommended as the risk of there being a bacterial infection is high.

Choices include single drug therapy like Ceftazidime or Cefoperazone if no catheter/prosthetic.

If there is a catheter, Vancomycin to cover MRSA must be considered.

It should also be considered if condition not improving after 72 hours.

Antifungal therapy should be considered if patient is not responding  for a week.

Re-evaluation should be a constant part of the care of the patient. Now, for the last 3-4 years, there is a move to treat neutropenic patients as outpatients.