Infectious emergencies in oncology patients

The development of neutropenia in a patient undergoing therapy for cancer represents a serious medical problem that rapidly escalates if fever develops. A diligent history and physical examination cannot be overemphasized, since this maneuver may direct the medical person to quickly identify the source of the infection and initiate appropriate therapy. No time should be wasted, but every attempt should be made to quickly obtain body fluids or tissue for microbiologic culture purposes. Appropriate therapy should then be instituted in an empiric manner. The antibacterial agents that are chosen as initial therapy should be selected based on a knowledge of the current local ecology and the antibiotic resistances of endemic strains of bacteria. The empiric therapy should continue until the patient has evidence of recovery of bone marrow function. In those patients who have developed obvious tissue infection, such as pneumonia or bloodstream infection, the therapy should be continued until the infection is eradicated. In patients who have persistent fever despite broad-spectrum antibacterial agents, a painstaking search for the source and type of infection should continue, including repeated blood cultures and other tests. Additional antibiotic or fungal agents should be administered as the need arises. Such an approach to this group of patients has resulted in a significantly better outcome for cancer patients. With the advent of recombinant hematopoietic growth factors, which may allow for a more rapid marrow and immunologic recovery, the therapy for the neutropenic patient should continue to improve.