Management of infections in febrile neutropenic patients with hematological malignancies

Background: Febrile neutropenia (FN) has traditionally been treated in the inpatient setting, however more recently models of risk stratification have been developed to identify oncology patients who may benefit from outpatient treatment or early discharge for home-based treatment once stable. Risk stratification is attractive because early discharge is associated with healthcare savings and decreased rates of nosocomial infection for low risk patients. Two widely used assessment tools, The Multinational Association for Supportive Care in Cancer (MASCC) and The Clinical Index of the Stable Febrile Neutropenia (CISNE) can be part of the patient interview. These tools can help to risk-stratify patients into a high-risk and low-risk neutropenic fever. Therapeutic management of febrile neutropenic patients should aim at a multifactor approach. This should include everything from adequate antibiotic therapy to the use of factors that implement immunity and help to control damage related to the underlying pathology, to chemotherapy or sepsis, such as thrombocytopenia, hemorrhagic phenomena and circulatory shock.