From the Infectious Diseases Society of America. Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever.

This is one in a series of reports by the Infectious Diseases Society of America to address issues in antimicrobial therapy. The neutropenic patient who becomes febrile has a >60 % likelihood of being infected. If the neutrophil count is <100 cells/1l, ,v20% or more of febrile episodes will have an associated bacteremia [1, 2]. These are caused principally by aerobic gram-negative bacilli (especially Escherichia coli, Kiebsiella pneumoniae, and Pseudomonas aeruginosa) and gram-positive cocci (in particular, coagulase-negative staphytococci, a-hemolytic streptococci, and Staphylococcus aureus) [3] (table 1). Fungi are common causes of secondary infections among neutropenic patients who have received courses of broad-spectrum antibiotics. Such patients are particularly difficult to evaluate because the factors that have rendered them granulocytopenic have resulted in an impaired inflammatory response. Therefore, the signs of inflammation are muted, requiring special consideration during historytaking and physical examination. It is notable that relatively few sites are affected and the cause of these infections is limited