Consensus guidelines for initial management of neutropenic fever

Area of Science:

• Infectious Diseases
• Hematology Oncology
• Clinical Practice Guidelines

Background:

• Cancer treatment advances and evolving infection management necessitate updated neutropenic fever guidelines.
• Antimicrobial use impacts gut microbiome and drives antimicrobial resistance, requiring careful consideration in empiric therapy.
• Epidemiology of antimicrobial resistance has shifted, influencing treatment strategies for neutropenic fever.

Purpose of the Study:

• To provide updated, evidence-based consensus recommendations for the initial empiric management of neutropenic fever in adults and children.
• To address key management questions considering recent changes in cancer care, sepsis management, and infection models.
• To incorporate current evidence on optimal empiric neutropenic fever therapy, acknowledging antimicrobial resistance concerns.

Main Methods:

• A multidisciplinary writing group (infectious diseases, microbiology, hematology, oncology, nursing, pharmacy) developed the guidelines.
• Extensive literature review was conducted to synthesize current evidence on neutropenic fever management.
• Consensus recommendations were formulated with evidence grading for initial empiric therapy.

Main Results:

• Consensus recommendations for initial empiric management of neutropenic fever are provided for adults and children.
• Guidelines include recommended investigations, antimicrobial therapy choices, and management strategies.
• Specific guidance is offered for patients with beta-lactam allergy or risk factors for multidrug-resistant infections.

Conclusions:

• These updated guidelines provide a framework for optimal initial empiric management of neutropenic fever.
• The recommendations aim to balance effective treatment with the growing concerns of antimicrobial resistance.
• Separate chapters address subsequent and ambulatory management strategies for neutropenic fever.