Emergency Department and Outpatient Specialty Care Clinical Pathway for Oncology Patient Presenting with Fever

Antibiotic Recommendations for Special Patient Populations
  • FLOC/RN team assessment
    • Push Provider Button if team not present
  • History, physical exam
    • RN
      CVC or IV access, CBC, blood culture
    • FLOC
      Oncology fever orders
      Order antibiotics
      Consider need for stress steroids
      Excluding engineered cell therapy patients
  • Complete History, Physical Exam
  • Further Diagnostic Studies
Broviac or PICC
No Line
If ANC < 200 in previous 24 hours, Review Low-Risk Criteria
If not Low Risk, give Cefepime instead of Ceftriaxone
Oncology Consult (ED)
No Neutropenia
No Neutropenia
Oncology Consult (ED)
Oncology Consult (ED)
Assess Risk
Low-Risk Criteria for Discharge for Fever/Neutropenia in Oncology patients with Port or No Line

To be considered for discharge, the patient must:

  • Have no defined bacterial illness
  • Have no visible disruption of mucocutaneous barriers and
  • Expected period of neutropenia is ≤ 7 days
Low-risk Criteria: Clinical Low-risk Criteria: Medical History Low-risk Criteria: Social
  • Age > 6 months
  • Tolerating PO, able to take enteral medications
  • HPI/PE consistent with likely viral illness
  • Reassuring physical exam, VS
  • Low concern for focal, invasive bacterial or fungal conditions such as:
    • Pneumonia
    • Cellulitis
    • Urinary tract infection
  • No history of:
  • Current neutropenia expected to last ≥ 7 days in a patient with leukemia/lymphoma
  • Relapse leukemia not in remission
  • BMT within preceding 12 months
  • Trisomy 21/Down Syndrome
  • Currently receiving therapy for GVHD
  • Received > 15 days of glucocorticoids in last 30 days
  • Current use of broad-spectrum antibiotics
  • Bacteremia within the last 30 days
  • Any surgery in the preceding 2 weeks, excluding line placement
  • VP shunt, Ommaya reservoir, or other implanted devices at present, excluding ports
  • Engineered Cell Therapy within past 100 days
  • Family able to:
  • Follow up in clinic in 24-72 hours
  • Receive daily follow-up calls
  • To fill Levofloxin prescription
Posted: February 2008
Revised: May 2022
Authors: Ku, B. MD; Reilly, A. MD; Jacobstein, C. MD; Lavelle, J. MD; Kersun, L. MD, Bailey, C. MD