Guidelines for Complications of Cancer Treatment Vol VIII Part B

Initial investigations – Complete blood count, blood ureanitrogen, serum creatinine, liver function test should be donein all patients. Oxygen saturation, chest X-rays and urineanalysis should be done depending on patients symptoms.(level-3)CulturesTwo blood samples should be obtained for culture. There arethree options: 1) Both samples can be from periphreral blood,2) one from peripheral blood and one from catheter, 3) bothfrom catheter. In the absence of clinical signs and symptomsroutine cultures from other sites are not recommended.(level-3)Initial empiric antibiotic therapy-All neutropenic patients with signs and symptoms of infectionshould receive empiric antibiotic to decrease mortality.Following factors should be considered before decidingantibiotics-Patient infection risk assessmentThe antimicrobials susceptibilities of organism isolated locallyThe most common potentially infecting organisms, incidenceof extended spectrumbeta-lactamase producing Gram negativerods (ESBL), vancomycin resistant enterococci (VRE) andcolonization with with or previous infection with methicillinresistant S. aureus (MRSA).Potential sites of infectionsBactericidal Antibiotics with antipseudomonal coverageClinical instabilityDrug allergyRecent antibiotic use374