Febrile Neutropenia
Patient Evaluation
The initial evaluation of the neutropenic patient with a fever should be done promptly and include a thorough history and physical examination.
History should include the following:
- Age and diagnosis
- Nature, cycle and course of chemotherapy
- Immunosuppressive agents used
- Prophylactic antibiotics, antifungals or antivirals used
- Previous episodes of infection/sepsis
Physical examination should be thorough and pay special attention to:
- Oropharynx
- Presence of sinus tenderness
- Skin, especially hidden and sites with reduced access: perineum, nails, bone marrow aspiration sites, central venous line sites and scalp
Blood tests including:
- CBC
- urea and electrolytes
- liver function tests
- C-Reactive Protein (CRP) and other infection markers if available
- Blood cultures should be taken before the administration of antibiotics.
- An appropriate volume of blood for culture is the most important factor for the detection of circulating pathogen.
- Appropriate volumes by age group are specified in table 1.
- Blood culture should be taken from both lumen in CVL or from peripheral site if absent.
- Blood cultures from PICC line site are not recommended.
TABLE 1:
BC CHILDREN’S HOSPITAL Recommended Blood Volumes for Blood Culture Collection:
Blood Culture Type |
Optimal Volume |
Minimum Volume |
Blood Culture Bottle* |
Aerobic Patient Weight: <1 kg |
|||
0.5-1.0 mL |
0.4 mL |
Peds Plus (pink top) |
|
1 – 3 kg |
1 mL |
0.5 mL |
|
1.0 - < 10 kg |
3 mL |
1 mL |
|
10 - < 25 kg |
5 mL |
3 mL |
|
25 - < 35 kg |
10 mL |
5 mL |
Bactec Plus Aerobic (grey top) |
> 35 kg |
10 mL |
5 mL |
|
|
Anaerobic** |
10 mL |
5 mL |
Bactec Lytic (purple top) |
|
Fungal *** |
10 mL |
5 mL |
≥ 3mL – Bactec Plus Aerobic (grey top) < 3mL – Peds Plus (pink top) |
|
Mycobacterial |
3 mL |
1 mL |
SPS vacutainer tube |
Note:
For all patients (aerobic/anaerobic and/or fungal requests) – if unable to collect > 3mL – use only Bactec Peds Plus bottle
* Two aerobic bottles are recommended in the initial investigation of bacteremia
**Anaerobic blood cultures are collected on physician request only
*** Can use same bottle as for aerobic culture
→ If dimorphic/filamentous fungi requested → contact laboratory – use Isolator tube (1.5mL or 10mL)
