Table 4.

Presentation and management of febrile neutropenia.

Syndrome	Presentation	Management
Superior Vena Cava Syndrome	❖A single oral temperature measured at ≥38.3 °C (101 °F) or a temperature of ≥38.0 °C (100.4 °F) sustained over a 1 h period combined with severe neutropenia, defined as an absolute neutrophil count (ANC) <500 cells/mm3 or an ANC that is expected to decrease to <500 cells/mm3 during the next 48 h. Presentation can bridge the spectrum from otherwise asymptomatic to moribund with florid hemodynamic collapse.	❖The current door-to-antibiotics guideline is <1 h after ED presentation, although recent research has shown that delays up to 3 h do not substantially affect outcomes. ❖Blood cultures, both peripheral and from indwelling lines, should be universally collected. ❖ Empiric monotherapy with an antipseudomonal β-lactam is recommended with the following exceptions: - Carbapenems for patients with a high risk of infection by an extended-spectrum β-lactamase-expressing organism. - Polymyxin-colistin in patients at high risk for a carbapenemase-producing Klebsiella. - Aztreonam, fluoroquinolones, or aminoglycosides for patients with an anaphylactic β-lactam allergy. ❖Vancomycin, linezolid, or daptomycin should be given only when either methicillin-resistant Staphylococcus aureus or indwelling catheter infections are likely and should be discontinued once these are ruled out. ❖Empiric antifungal coverage is not recommended at the time of presentation.