Febrile neutropenia treatment guideline sunnybrook hospital. Febrile neutropenia fn is a common complication in cancer patients receiving myelosuppressive chemotherapy. A recent study conducted by our research group reported that even if cancer patients were given prophylactic myeloid growth factor support, 16. Febrile neutropenia is a lifethreatening complication often associated with cytotoxic chemotherapy and malignancies that has a significant impact on morbidity and mortality. Febrile neutropaenia is the development of fever, often with other signs of infection, in a patient with neutropaenia, an abnormally low number of neutrophil. This study was designed to estimate us healthcare utilization and costs in those experiencing fn by location of care, tumour type and mortality. In the united states in 2012, 91,560 adults and 16,859 children with cancer were treated at a hospital because of neutropenia. Accordingly, algorithmic approaches to fever and neutropenia, infection prophylaxis, diagnosis, and treatment have been received 29 october 2010.
Clinical practice in febrile neutropenia risk assessment. Risk and consequences of chemotherapyinduced febrile neutropenia in patients with metastatic solid tumors. Short courses of intravenous empirical antimicrobial treatment in selected febrile neutropenic children with cancer. Febrile neutropenia history and exam bmj best practice. Empiric antifungal therapy is rarely required before day 7 of febrile neutropenia visit the renal adjustment page for more information. Methods we conducted a retrospective cohort study for the 2006 calendar year involving all adult oncology patients presenting with febrile neutropenia to a regional health authoritys emergency departments. Febrile neutropenia bacterial infection neutropenia. Assessment and management of febrile neutropenia in.
Prompt administration of antibiotics is associated with improved outcomes in febrile neutropenia in children with cancer. Managing febrile neutropenia in pediatric oncology. Chemotherapyinduced febrile neutropenia fn is a serious adverse event caused by cancer therapies that can have a significant impact. Febrile neutropenia fn, described as a neutrophil count 38. Any physician using these guidelines to provide treatment. In children with lowrisk febrile neutropenia, consider. Sb febrile neutropenia guideline 2019 november 11, 2019 pdf. In pediatric news, asco announced this week that it is endorsing a guideline developed by the international pediatric fever and neutropenia guideline panel j clin oncol. Pediatric patients at risk for fever in chemotherapyinduced neutropenia in bern, switzerland, 1993 2012. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer.
Approaches to febrile neutropenia 2011 idsaecil guidelines johan maertens, md, phd department of hematology. Febrile neutropenia occurs when a patient has a fever and a significant reduction in a type of white blood cells, known as neutrophils, which are needed to fight infections. Patients with febrile neutropenia who are felt to be at low risk of complications may be managed as an outpatient see table 2 in the original guideline document for characteristics of patients at low risk for complications and high risk for complications from febrile neutropenia. Febrile neutropenia fn following myelosuppressive chemotherapy is associated with substantial mortality and costs 1,2. Guideline for the management of fever and neutropenia in. Many patients, when undergoing cancer treatment, will experience a reduction in their white blood cells, which may be temporary or may persist for some time. Piperacillintazobactam for empirical therapy of febrile. Chemotherapyinduced febrile neutropenia fn is a serious adverse event caused by cancer therapies that can have a significant impact on mortality, morbidity and health care costs. A neutrophil is a type of white blood cell that helps fight infection. The majority of cancer patients develop neutropenia, most often due to chemotherapy.
Risk of infection increases 10fold with declining neutrophil counts neutropenia febrile neutropenia. Adult febrile neutropenic patient anc febrile patients through the neutropenic period. Oct 11, 2015 febrile neutropeniafebrile neutropenia neutropenia is usually defined as an absolute neutrophil count ancneutropenia is usually defined as an absolute neutrophil count anc below 1500 cellsmicrol may 08, 20 febrile neutropniafever is defined as a single oral temperature of38. Hospital discharges for fever and neutropenia in pediatric cancer patients. Prevention and treatment of cancerrelated infections pdf. Febrile neutropenia fn infections in cancer patients receiving chemotherapy should be considered medical emergencies requiring immediate medical evaluation and administration of empirical broadspectrum antibiotics. Assessment and management of febrile neutropenia in emergency.
Listing a study does not mean it has been evaluated by the u. Cohort study of the impact of time to antibiotic administration on mortality in patients with febrile neutropenia. Management of febrile neutropenia in the era of bacterial resistance. The term neutropenic sepsis is also applied, although it tends to be reserved for patients who are less well. Management of the nonlowrisk patients with febrile neutropenia. Febrile neutropenia is considered an oncologic emergency, for which prompt initiation of antibiotics is essential. Febrile neutropenia is defined as a single oral temperature measurement of 101f 38. Febrile neutropenia patient information sheet what does febrile mean. Febrile neutropenia is the development of fever, often with other signs of infection, in a patient with neutropenia, an abnormally low number of neutrophil granulocytes a type of white blood cell in the blood. Febrile neutropenia is defined as an oral or tympanic membrane temperature of. Febrile neutropeniafebrile neutropenia neutropenia is usually defined as an absolute neutrophil count ancneutropenia is usually defined as an absolute neutrophil count anc below 1500 cellsmicrol 2012.
Economic implications of chemotherapyinduced febrile neutropenia fn in european and australian clinical practice are largely unknown. Aug 22, 2012 economic implications of chemotherapyinduced febrile neutropenia fn in european and australian clinical practice are largely unknown. Patients with febrile neutropenia who are felt to be at low risk of complications may. Data were obtained from a european 97% and australian 3% observational study of patients with nonhodgkins lymphoma nhl receiving chop rituximab chemotherapy. Current guidelines recommend primary prophylaxis with colonystimulating factors csfs, such as granulocyte colonystimulating factor gcsf, when the fn risk is 20% or greater 3,4. Empiric antibiotic therapy upon presentation has dramatically improved outcomes and decreased mortality from febrile neutropenia.
Guidelines in the management of febrile neutropenia for. The classic treatment strategy has been broadspectrum antibiotics administered intravenously in a hospital setting, and most patients respond promptly with no complications. Febrile neutropenia symptoms, diagnosis and treatment. In the absence of serious infections, gcsf is not indicated to improve clinical outcomes, but may reduce hospitalization by 1 day. Febrile neutropenia fn is a potentially lifethreatening condition that may develop in cancer patients treated with myelosuppressive chemotherapy and result in considerable costs. In children with lowrisk febrile neutropenia, consider initial or stepdown outpatient management if infrastructure is in place to ensure careful monitoring and followup. Febrile neutropenia an overview sciencedirect topics. Neutropenia in the febrile child pediatric emergency care. The risk of febrile neutropenia in patients with nonsmall. For each patient, each cycle of chemotherapy within the course, and each occurrence of. Approaches to febrile neutropenia 2011 idsaecil guidelines johan maertens, md, phd department of hematology university hospitals leuven leuven, belgium. Episodes of fever in neutropenia in pediatric patients with cancer in bern, switzerland, 19932012.
A recent study conducted by our research group 1 reported that even if cancer patients were given prophy. Management of febrile neutropenia in adult cancer patients. Febrile neutropenia symptoms, diagnosis and treatment bmj. Costs associated with febrile neutropenia in solid tumor. Everything nice has said on preventing, identifying and managing neutropenic sepsis. Patients with febrile neutropenia are at high risk of increased mortality, and this neutropenic complication is considered. The classic treatment strategy is broadspectrum antibiotics administered intravenously in a hospital setting, and most patients respond promptly with no complications. Febrile neutropenia fn is characterized by a decrease in neutrophils number to values below 500 cells mm3 and an occurrence of fever higher or similar to38. For 2012, we identified 91,560 cancerrelated neutropenia. Having too few neutrophils increases the risk of infection. Neutropenia is defined as an anc of neutropenia patients are also at risk noninfectious causes of fever should be excluded.
Neutropenia is defined as a neutrophil count ofless than 500 cellsmm3, or a count of less than cellsmm3 with a predicted decrease tobelow 500 cellsmm3 in next 48 hours. Development and validation of the mascc risk index score febrile neutropenia fn is a lifethreatening complication of cancer chemotherapy and is considered a medical emergency. Research article open access costs associated with febrile. Fn may result in dose reductions, delays, or even discontinuation of chemotherapy, which, in turn, may compromise patient outcomes. Febrile neutropenia in haematological malignancies sharma a, lokeshwar n abstractabstract fever is the principle sign of infection in neutropenic patient and frequently may be the only evidence of infection. Febrile neutropenia, neutropenia, fever, cost analysis, factors background febrile neutropenia fn is a common complication in cancer patients receiving myelosuppressive chemotherapy. What you need to know neutropenia and risk for infection cdc.
For patients with neutropenia, even a minor infection can quickly become serious. Prospective multicentric study of the etiology of 1051 bacteremic episodes in 782 cancer patients. Neutropenia is a wellrecognised complication of chemotherapy, associated with an increased risk of infection, febrile neutropenia fn, and as. Utilizing the mascc and cisne risk criteria enables health care providers to categorize a patients risk for serious medical complications from infections. Febrile neutropenia fn is a lifethreatening complication of cancer chemotherapy and is considered a medical emergency.
Cost of cancerrelated neutropenia or fever hospitalizations, united. Outline of management article pdf available in the indian journal of pediatrics 802 november 2012 with 1,2 reads how we measure reads. Neutropenia with fever febrile neutropenia fn is a serious consequence of myelosuppressive chemotherapy that usually results in hospitalization and the need for intravenous antibiotics. Costs associated with febrile neutropenia in the us. Patient factors and their impact on neutropenic events. The use of the mascc score for predicting patients with febrile neutropenia fn and a high risk of complications were also established by blot and nitenberg. Management and preventive measures for febrile neutropenia. Approaches to febrile neutropenia 2011 idsaecil guidelines. Definition of febrile neutropenia nci dictionary of. Among cancer patients presenting with an episode of fn, one series found that 30%. The risk of fn depends on the chemotherapy regimen and also on the general condition of the patient, the presence of comorbidities, and the tumour stage. Febrile neutropenia fn was defined as an oral temperature 38.
Metaanalysis of possible signal of increased mortality associated with cefepime use. Economic costs of chemotherapyinduced febrile neutropenia. Guideline for the management of fever and neutropenia in children with cancer andor undergoing hematopoietic stemcell transplantation. Outpatient and oral antibiotic management of lowrisk febrile neutropenia are effective in children. Oct 26, 2012 the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. A fever is defined as a single oral temperature of greater than or equal to 38. The depth and duration of neutropenia correlate with the risk of developing infection and death 1 episodes of febrile neutropenia fn are considered an oncologic emergency. The pattern of fever in neutropenia is nonspecific and not pathognomonic of any type of infections.