Summary
Definition
History and exam
Other diagnostic factors
- age >65 years
- prior episodes of neutropenia following chemotherapy
- Eastern Cooperative Oncology Group performance status (ECOG PS) ≥1
- haematological malignancies
- prior antibiotic regimens
- albumin <35 g/L (<3.5 g/dL)
- pretreatment haemoglobin <120g/L (<12 g/dL)
- low first-cycle nadir absolute neutrophil count (<500 cells/microlitre)
- abnormal breath sounds or cough
- shortness of breath
- abdominal pain
- nausea or vomiting
- diarrhoea
- dysuria and pyuria
- skin erythema, warmth, tenderness
- mucositis or oral ulcers
- infection, inflammation, or ulceration of genital and anal area
- infected indwelling catheters
- concurrent radiotherapy
- exposures to infections
- sinus tenderness
Risk factors
- age >65 years
- albumin <35 g/L (<3.5 g/dL)
- pre-existing organ dysfunction (heart, liver, kidney disease)
- pre-treatment haemoglobin <120 g/L (<12 g/dL)
- full-dose intensity chemotherapy
- low first-cycle nadir absolute neutrophil count (<500 cells/microlitre)
- haematological malignancies
- concurrent radiotherapy
- prior episodes of neutropenia following chemotherapy
- female sex
- Eastern Cooperative Oncology Group performance status (ECOG PS) >1
- advanced-stage disease
- prior chemotherapy
- corticosteroids
Diagnostic investigations
1st investigations to order
- FBC and differential
- urea and creatinine
- liver function tests (LFTs)
- blood cultures for bacteria: peripheral and central venous catheters
- chest x-ray
Investigations to consider
- stool culture
- urine culture
- lumbar puncture
- fungal cultures and serologies (beta-glucan and galactomannan)
- viral molecular assay
- echocardiogram
- CT scans of the chest, abdomen, and pelvis
Treatment algorithm
Contributors
Authors
Kenneth V. I. Rolston, MD
Internist and Professor of Medicine
Department of Infectious Diseases, Infection Control and Employee Health
Division of Internal Medicine
The University of Texas M.D. Anderson Cancer Center
Houston
TX
Disclosures
KVIR has research grants from Merck, Inc., Shionogi, and JMI Laboratories for the performance of in-vitro studies of novel antimicrobial agents.
Lior Nesher, MD
Specialist in Infectious Disease & Internal Medicine
Infectious Disease Institute, Soroka Medical Center
Senior Lecturer, Faculty of Health Sciences
Ben-Gurion University of the Negev
Beer Sheba
Israel
Disclosures
LN has given two educational lectures sponsored by MSD.
Acknowledgements
Dr Kenneth Rolston and Dr Lior Nesher would like to gratefully acknowledge Dr Caron Jacobson and Dr Joseph Antin, previous contributors to this topic.
Disclosures
CJ and JA declare that they have no competing interests.
Peer reviewers
John Wingard, MD
Price Eminent Scholar and Professor of Medicine
Director
Bone Marrow Transplant Program
Division of Hematology/Oncology
University of Florida College of Medicine
Gainesville
FL
Disclosures
JW has been reimbursed by Pfizer, Merck, Astellas, and Enzon for speaking fees, fees for educational programs, and consulting.
Matthew Falagas, MD, MSc, DSc
Director
Alfa Institute of Biomedical Sciences
Marousi
Athens
Greece
Disclosures
MF declares that he has no competing interests.
Ruth Pettengell, MBChB FRACP PhD
Senior Lecturer in Haematology
Honorary Consultant in Medical Oncology
St George's University of London
London
UK
Disclosures
RP has received speaker fees and been reimbursed by Roche, Amgen, Chigai, and Bayer for attending several conferences. RP is a co-author of the EORTC guidelines referenced in this topic.
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