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Persistent FN — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesPersistent FNSCE Medical Oncology

A 55-year-old woman on chemotherapy develops febrile neutropenia with ANC 0.2 × 10⁹/L. Blood cultures grow Pseudomonas aeruginosa. She is on IV piperacillin-tazobactam but remains febrile at 48 hours. What should be done?

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Correct answer: D — Review antibiotic sensitivities, consider adding an aminoglycoside (gentamicin) for synergistic double Gram-negative cover, reassess for deep-seated infection (CT chest/abdomen) and consider fungal cover if >96 hours febrile

Persistent fever at 48 hours in neutropenic sepsis despite appropriate first-line antibiotics warrants: (1) review culture sensitivities and adjust antibiotics accordingly, (2) consider aminoglycoside addition for synergistic Pseudomonas cover, (3) CT imaging to identify deep-seated infection (typhlitis, hepatosplenic candidiasis, pneumonia), (4) line tip cultures if line infection suspected, (5) if persistent fever >96 hours with no identified source, add empiric antifungal therapy (liposomal amphotericin B or caspofungin) per NICE CG151.

Reference: NICE CG151; ESMO Supportive Care; BNF