Management of the febrile neutropenic patient in 2023

Febrile neutropenia (FN) is a well-known complication of chemotherapy (CHT) regimens, which appears more frequently in patients receiving CHT for hematologic malignancies, than those with solid tumors. Given the fact that this condition is life threatening, as well as multiple complications that may happen, rapid intervention is required, administration of empirical antibiotic therapy being necessary in the first hour of admission. Due to the high mortality rate associated with Pseudomonas aeruginosa infections, patients at risk should be given an antipseudomonal antibiotic agent, such as cefepime, carbapenem or piperacillin-tazobactam. Regarding empirical antibiotic coverage for gram-positive microorganisms, this is preserved for hypotensive patients, with skin/soft infections or suspected catheters infection or those taking fluoroquinolone. Considering the fact that a variety of bacterial, viral and fungal pathogens are responsible for high morbidity and mortality among patients with FN, preventable measures like antibiotic, antifungal and antiviral, as well as vaccination and prophylaxis with G-CSF, are crucial components in providing medical treatment for onco-hematological patients.