Empiric Antimicrobial Therapy in the Community Hospital Setting for the Cancer Patient with Fever and Neutropenia: The Need for Vigilance and Attention to Detail
The neutropenic patient who becomes febrile has a 60% probability of being infected. With extremely low neutrophil counts (MINGlt;100), the likelihood of bacteremia is approximately 20% (Consensus Panel, Immunocompromised Host Society 1990; Klastersky et al. 1988; Hughes et al. 1990; de Pauw et al. 1990; Pizzo 1989; Hathorn 1989; Lazarus et al. 1989). Untreated or inadequately treated, these infections are often rapidly fatal. The timely and effective treatment of these patients with empiric antibiotics requires attention to detail. Initial evaluation with complete history and physical examination may be lacking important elements when done in settings such as the family doctor’s office or the emergency department of the community hospital. After admission to the community hospital, the patient may be cared for by a private attending physician who sees the patient briefly once daily. If the patient is on a teaching service in a community hospital, the house staff may have varying levels of confidence and experience in dealing with the rapidly evolving syndromes in immunocompromised hosts. Contrast this with the care given in a major university center. The febrile patient is surrounded by house staff and fellows from the departments of hematology, and oncology and infectious diseases. They are customarily enrolled in the in-house sepsis protocol and reevaluated frequently and cultured extensively.
KeywordsCommunity Hospital Neutropenic Patient House Staff Empiric Antimicrobial Therapy Febrile Neutropenic Patient
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