Febrile neutropenia

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. The term neutropenic sepsis is also applied, although it tends to be reserved for patients who are less well. Fever is actually caused by infection in 50% of cases, and bacteremia (bacteria in the bloodstream) may be present in as many as 20% of all patients with an absolute neutrophil count under 1.0.^[1]

Febrile neutropenia can develop in any form of neutropenia, but is most generally recognized as a complication of chemotherapy when it is myelosuppressive (suppresses the bone marrow from producing blood cells). Generally, patients with febrile neutropenia are treated with empirical antibiotics until the neutrophil count has recovered and the fever has abated; if the neutrophil count does not improve, treatment may need to continue for two weeks or occasionally more. Guidelines issued in 2002 by the Infectious Diseases Society of America recommend the use of particular combinations of antibiotics in specific settings; mild low-risk cases may be treated with a combination of oral co-amoxiclav and ciprofloxacin, while more severe cases require cephalosporins with activity against Pseudomonas aeruginosa (e.g. cefepime), or carbapenems (imipenem or meropenem).^[1] A subsequent meta-analysis published in 2006 found that cefepime was associated with more negative outcomes, and that carbapenems (while causing a higher rate of pseudomembranous colitis) were the most straightforward in use.^[2]

The Multinational Association for Supportive Care in Cancer (MASCC) Risk Index can be used to identify low-risk patients (score ≥21 points) for serious complications of febrile neutropenia (including death, intensive care unit admission, confusion, cardiac complications, respiratory failure, renal failure, hypotension, bleeding, and other serious medical complications).^[3] The score was developed to select patients for therapeutic strategies that could potentially be more convenient or cost-effective. A prospective trial demonstrated that a modified MASCC score can identify patients with febrile neutropenia at low risk of complications as well.^[4]

See also

• Neutropenia
• Leukocytopenia
• Fever
• Myelosuppression
• Chemotherapy

References

1. ^ ^{a b} Hughes WT, Armstrong D, Bodey GP, et al. (March 2002). "2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer". Clin. Infect. Dis. 34 (6): 730–51. doi:10.1086/339215. ISSN 1058-4838. PMID 11850858. http://www.journals.uchicago.edu/doi/full/10.1086/339215. 
2. ^ Paul M, Yahav D, Fraser A, Leibovici L (February 2006). "Empirical antibiotic monotherapy for febrile neutropenia: systematic review and meta-analysis of randomized controlled trials". J. Antimicrob. Chemother. 57 (2): 176–89. doi:10.1093/jac/dki448. ISSN 0305-7453. PMID 16344285. http://jac.oxfordjournals.org/cgi/content/full/57/2/176. 
3. ^ Klastersky J, Paesmans M, Rubenstein EB, et al. (16 August 2000). "The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients.". J Clin Oncol. 18 (16): 3038–51. ISSN 0732-183X. PMID 10944139. http://jco.ascopubs.org/cgi/content/full/18/16/3038. 
4. ^ de Souza Viana L, Serufo JC, da Costa Rocha MO, Costa RN, Duarte RC (July 2008). "Performance of a modified MASCC index score for identifying low-risk febrile neutropenic cancer patients". Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer 16 (7): 841–6. doi:10.1007/s00520-007-0347-3. ISSN 0941-4355. PMID 17960431. 

External links

• Febrile neutropenia entry in the public domain NCI Dictionary of Cancer Terms