Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

Risk Factors

Patients at Low Risk

  • Clinically stable

  • ANC greater than 0.1 x 10⁹/L

  • Absolute monocyte count greater than 0.1 X 10⁹/L

  • No acute process on chest radiograph

  • Duration of neutropenia less than or equal to 7 days

  • Resolution of neutropenia expected in less than 10 days

  • Near normal liver and renal function

  • No IV catheter site infections

  • Peak temp of less than 39 °C

  • No neurologic or mental changes

  • No abdominal pain

  • No comorbid illness – COPD, DM, shock, hypoxia, pneumonia, etc.

Patients at High Risk

  • Sustained, profound neutropenia anticipated to last greater than 1 week

  • Clinically unstable

  • Hemodynamic instability

  • Altered mental status

  • Uncontrolled cancer

  • Severe mucositis

  • Intravascular catheter infection

  • Pneumonia

  • Other complex infection at presentation or have significant medical comorbidities, such as:

  • COPD

  • Hepatic insufficiency

  • Renal insufficiency

  • Poor functional status

  • Advanced age