ABSTRACT
Despite the progress made in supportive care in oncology, infection is a very common, and occasionally serious, problem. Local factors, severity of neutropenia, cellular/humoral immune dysfunction and foreign body increase the susceptibility of cancer patients to infection. Since patients with generalized malignancy, transplant recipients, and patients being treated with immunosuppressive or radiation therapy are all considered to have altered immunocompetence, preventive strategy should be considered. Neutropenic fever is a true medical emergency. Without timely administration of proper antibiotics, sepsis syndrome and even death might occur. The education of patients and family members as well as appropriate initial management is of critical importance. At presentation of neutropenic fever, risk assessment for complications should be performed. Gram-negative bacteria have been the most common pathogens detected in neutropenic patients, but recently these have been overtaken by Gram-positive cocci. Since Gram-negative bacteremia is associated with higher mortality than Gram-positive bacteremia, initial empirical antibiotic coverage especially for Pseudomonas aeruginosa is essential. Only carefully selected adult patients with neutropenic fever who are at low risk for complications may be treated initially with oral antibiotics. Remaining high-risk patients require hospitalization for IV empirical antibiotics therapy such as carbapenems (imipenem–cilastatin or meropenem), or piperacillin–tazobactam are recommended.
