Key messages

• Neutropenia can be 'mild' (1.0-1.8 x 109/|), 'moderate' (0.5-1.0 x 109/I), or 'severe' (< 0.5 x 109/I).

• Patients with severe neutropenia, particularly when levels are below 0.2 x 10 9/I, are at significant risk of infection, usually by bacterial invasion arising from the mouth and intestinal tract.

• The spectrum of bacteria isolated during febrile neutropenia has changed in the last decade from predominantly Gram-negative to Gram-positive organisms.

• Other factors have important influences on the risk and type of infection: the duration of neutropenia, defects in other immune system components, nutritional status, previous splenectomy, skin and mucous membrane integrity, and the use of blood components.

• Severely neutropenic patients are unable to mount a normal inflammatory response. Normal signs and symptoms of infection may be absent or muted, and the patient can deteriorate rapidly. It is imperative to monitor closely and treat immediately if infection is suspected.

• In severe neutropenia it is essential to start treatment promptly (before results of cultures) with an empirical antibiotic regimen that is bactericidal and has a broad spectrum of activity, particularly against virulent Gram-negative bacteria such as Pseudomonas aeruginosa.

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