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Infectious Diseases



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.



BC CHILDREN’S HOSPITAL Recommended Blood Volumes for Blood Culture Collection:

Blood Culture Type

Optimal Volume

Minimum Volume

Blood Culture Bottle*


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


10 mL

5 mL

Bactec Lytic (purple top)

Fungal ***

10 mL

5 mL

≥ 3mL – Bactec Plus Aerobic

                  (grey top)

< 3mL – Peds Plus (pink top)


3 mL

1 mL

SPS vacutainer tube


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)




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