Neutropenic Fever

Clinical indications for coverage of ESBL-producing bacteria:

• Documentation of prior infections or colonization with ESBL-producing organisms in past 12 months OR

• Receipt of ≥2 courses of beta-lactam/fluoroquinolone antibiotics (pip-tazo, cefepime, levofloxacin, etc) in past 90 days

Note: Receipt of fluoroquinolone prophylaxis or as a single course is not an indicator for ESBL risk

Clinical indications for additional Gram-positive coverage:

• Suspected catheter-related infection, OR

• Probable skin and soft tissue infection, OR

• Hemodynamic instability, OR

• Preliminary culture positive for Gram-positive cocci

Clinical indications for aspergillosis coverage:

≥1 of:

• Unexplained fever >96 hours despite broad-spectrum antibiotics, OR

• Sinus CT suggestive of fungal infection, OR

• Recovery of fungus from any site

AND ≥1 of:

• Chest or sinus CT with macronodules ± halo sign, OR

• History of invasive aspergillosis, OR

• Patients undergoing intensive chemotherapy for AML/MDS, OR

• HSCT recipients with anticipated prolonged neutropenic periods of at least 14 days

Clinical indications for fungal coverage:

• Unexplained fever >96 hours despite broad-spectrum antibiotics, OR

• Sinus CT suggestive of fungal infection, OR

• Recovery of fungus from any site