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Febrile neutropenia — ABIM Board MCQ

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HardHematology/OncologyFebrile neutropeniaABIM Board

A 55-year-old woman receiving induction chemotherapy for acute myeloid leukemia has fever 38.7 C. Absolute neutrophil count is 90/mm3. Blood pressure is normal and she has no localizing symptoms. Which of the following is the most appropriate management?

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Correct answer: A — Immediate empiric antipseudomonal beta-lactam therapy after cultures

Febrile neutropenia is an emergency. Blood cultures should be obtained promptly, but empiric antipseudomonal beta-lactam therapy should start rapidly; vancomycin is reserved for specific indications such as catheter infection, skin infection, pneumonia, or instability.

Reference: IDSA Fever and Neutropenia Guideline; NCCN Prevention and Treatment of Cancer-Related Infections