SEOM clinical practice guideline: management and prevention of febrile neutropenia in adults with solid tumors (2018)

Abstract

Febrile neutropenia (FN) is a common dose-limiting toxicity of chemotherapy, with a profound impact on the evolution of patients with cancer, due to the potential development of serious complications, mortality, delays, and decrease in treatment intensity. This article seeks to present an updated clinical guideline, with recommendations regarding the diagnosis, prevention, and treatment of febrile neutropenia in adults with solid tumors. The aspects covered include how to properly approach the risk of microbial resistances, epidemiological aspects, considerations about the initial empirical approach adapted to the risk, special situations, and prevention of complications. A decision-making algorithm is included for use in the emergency department based on a new, validated tool, the Clinical Index of Stable Febrile Neutropenia, which can be used in patients with solid tumors who appear stable in the initial phase of neutropenic infections, and can help detect those at high risk for complications in whom early discharge must be avoided.

Current management of chemotherapy-induced neutropenia in adults: key points and new challenges

“…The CISNE model ( Figure 2 ) 23 , 28 is a predictive tool for FN patients who seem to be initially stable but subsequently develop serious complications. The CISNE scoring system has convenient online calculators that are accessible on computers or mobile phones to provide risk assessment ( https://www.mdcalc.com/clinical-index-stable-febrile-neutropenia-cisne ).…”

“…The discharge criteria for high risk patients should meet two important points: the blood culture is negative, and the patient is identified as having stable FN. However, for those patients with low/intermediate risk of FN complications (i.e., a CISNE score 0–2), coinfections and clinical risk factors must be excluded 28 .…”

Untitled

“…Обе работы показали снижение риска развития ФН у данной категории пациентов. Раздел о применении КСФ с целью профилактики ФН включен в опубликован ные в 2018 г. рекомендации Испанского общества меди цинской онкологии (SEOM) по терапии и профилактике ФН у взрослых пациентов с солидными опухолями [52].…”

Bacteriological Spectrum and Antimicrobial Sensitivity of Pathogens in Children with Hematologic Malignancies and Febrile Neutropenia Research

“…Since the advent of empiric administration of broadspectrum antibiotics at fever onset in neutropenic patients, guidelines have emphasized that the timely diagnosis and early initiation of supportive care and empiric broad-spectrum antibiotics are mandatory to prevent complications in FN patients (17)(18)(19)(20). Choosing the best antibiotic regimen in FN increases empiric antibiotic therapy's efficacy and decreases morbidities and health care costs.…”