Protocolo diagnóstico y tratamiento de la neutropenia febril

The onset of fever is a common complication in patients with neutropenia, defined as a granulocyte count below 500 cells/mcl. Patients with comorbidities or neutropenia of more than 7 days duration are considered at high risk. In less than a third of cases, a causative microorganism is identified after blood culture. History taking should focus on new symptoms. A full physical examination should be made paying particular attention to the skin due to the frequent onset of signs indicative of its aetiology. Diagnostic tests should be requested according to clinical suspicion. Because it is so difficult to differentiate serious clinical pictures from mild ones, all patients should be started on broad antibiotic treatment. Empirical coverage of Gram positive and Gram negative is recommended. If fever persists after the fourth day the addition of an antifungal agent can be considered.