Fever in a patient who has had chemotherapy in the past few weeks is neutropenic sepsis until proven otherwise. Do not wait for the blood count before acting.
Take blood cultures, from a central line and peripherally where possible, and give broad-spectrum intravenous antibiotics within an hour of arrival, following local protocol. A single temperature of 38.3 °C, or 38.0 °C sustained, with neutrophils below 0.5 × 10⁹/L, or expected to fall below it, meets the definition.
Risk tools such as the MASCC score can identify low-risk patients who may complete treatment as outpatients on oral antibiotics, but only once they have been assessed and are stable.
Teach every patient to come in immediately with fever, and give them a card that says they are on chemotherapy.
- Give IV antibiotics within an hour of arrival without waiting for the count
- Take blood cultures from each lumen of any central line as well as peripherally
- Use the MASCC score to identify low-risk patients for possible oral or outpatient care
- Give every chemotherapy patient a written alert card and a 24-hour number
Why it matters
Delays in the first hour drive much of the mortality in febrile neutropenia.
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