A fever in a patient with neutropenia is considered a medical emergency. The fever signals a severe decrease in neutrophils and therefore a compromised ability of the immune system to ward off infections.
Neutropenic fever is defined as a temperature of at least 101°, or a sustained temperature of at least 100.4° for an hour or more.
The Infectious Disease Society of America and the American Society of Clinical Oncology have both published guidelines for treating outpatients who have neutropenic fever.
Both organizations call for administering an intravenous antibiotic within 60 minutes after the fever is detected. The recommendation about antibiotics is also often applied to the treatment of hospital inpatients, but there’s no clear and appropriate evidence.
Guidelines for Treating Outpatients may not Apply to Hospitalized Patients
For evidence, researchers looked back at data on 187 patients at their hospital who had developed a neutropenic fever. Their main goal was to see whether delays in antibiotic treatment affected short-term survival.
Only 14% of patients received antibiotics within 60 minutes of developing a neutropenic fever. Their survival rate 6 months later wasn’t significantly better than the survival rate of patients who received antibiotics later than recommended.
Even a delay of more than 4 hours wasn’t long enough to affect survival. This result is consistent with information from previous studies of inpatients.
Researchers believe existing treatment guidelines are appropriate for patients with neutropenic fever who are treated in a physician’s office or an emergency department, but other factors must be considered for patients who have been admitted to a hospital.
Unlike neutropenic fever patients presenting to the emergency department, where true time to antibiotic administration may often be many hours or even days before arrival, a few hours long [delay] in the hospital may not be sufficiently long enough to cause significant patient harm.