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Canadian Journal of Infectious Diseases
Volume 11 (2000), Suppl D, Pages 27D-33D
http://dx.doi.org/10.1155/2000/509358

Adult Patient Care Plan: Management of the Febrile Neutropenic Cancer Patient on an Outpatient Basis

Coleman Rotstein,1 Eric J Bow,2 and The Febrile Neutropenia Care Plan Working Group

1McMaster University, Division of Infectious Diseases, Henderson Site, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
2Departments of Internal Medicine and Medical Microbiology, Sections of Infectious Diseases and Haematology/Oncology, Head, Section of Haematology/Oncology, The University of Manitoba, and Department of Medical Oncology and Haematology, CancerCare Manitoba, Winnepeg, Manitoba, Canada

Copyright © 2000 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Invasive infection may complicate the course of neutropenic cancer patients receiving intensive chemotherapy. The rate of complications is related to prognostic factors including the underlying malignant diagnosis, the state of responsiveness of the underlying disease to treatment, the dose-intensity of the cytotoxic therapy, the duration of neutropenia, the performance status of the patient and comorbid conditions. The pathogens involved are usually the patients’ endogenous microflora, and the sites of infection are those anatomic sites colonized with the endogenous microflora. The approach to the febrile neutropenic episode requires a sequence of steps including the recognition of the febrile state (oral temperature higher than 38°C), the depth and duration of the neutropenia (absolute neutrophil count less than 0.5×109/L), the identification of a clinical focus of infection and a potential pathogen, the administration of empirical antibacterial therapy, and finally, an assessment of the outcome. Management decisions about whether to treat with oral or parenteral antibacterial agents, with a combination or single agent therapy, or as an inpatient or an outpatient can be based on an assessments of risks of the severity of the patient’s comorbid conditions and the patient’s risk of developing medical complications that would require inpatient management. The duration of antimicrobial treatment depends on the recovery from the state of neutropenia and the origin of the infectious process.