REBEL Core Cast 122.0 – Neutropenic Fever

Neutropenic fever is a high-mortality medical emergency defined by a temperature over 38.3°C and an absolute neutrophil count (ANC) below 500 cells/mm³. While historically driven by gram-negative bacteria, the prevalence of gram-positive infections has risen due to fluoroquinolone prophylaxis, though antibiotic resistance is currently shifting the balance back toward gram-negative organisms. Management requires immediate stabilization and broad-spectrum antibiotics, typically a single anti-pseudomonal agent like cefepime or piperacillin-tazobactam. Specific complications such as mucositis or typhlitis—characterized by the triad of neutropenia, fever, and right lower quadrant pain—necessitate targeted imaging and potentially adding vancomycin. Risk stratification tools like the MASCC and CISNE scores can identify low-risk patients eligible for outpatient oral therapy, though most presentations require inpatient IV treatment. Early identification, review of prior cultures, and consultation with infectious disease specialists are essential to reducing mortality rates, which can reach 90% without intervention.