Febril Nötropeni: Yoğun Bakım Ünıtesinde Tanı, Yönetim ve Prognoz
Yoğun Bakımda Hematolojik ve Onkolojik Aciller, Volkan İnal,Pervin Hancı Yılmaztürk, Editör, Turkiye Klinikleri, Ankara, ss.4-11, 2026
- Yayın Türü: Kitapta Bölüm / Diğer
- Basım Tarihi: 2026
- Doi Numarası: 10.5336/978-625-91119-1-9
- Yayınevi: Turkiye Klinikleri
- Basıldığı Şehir: Ankara
- Sayfa Sayıları: ss.4-11
- Editörler: Volkan İnal,Pervin Hancı Yılmaztürk, Editör
- Trakya Üniversitesi Adresli: Evet
Özet
Febrile neutropenia is an oncological emergency characterised by neutropenia [Absolute Neutrophil Count (ANC) <500/mm³] and fever (single temperature ≥ 38.3°C or ≥38°C sustained for >1 hour) in cancer patients receiving chemotherapy. Due to profound immunosuppression, classical signs of infection are often absent, with fever frequently being the only early manifestation. In patients requiring intensive care unit admission, rapid progression to sepsis, septic shock, respiratory failure, and multiple organ dysfunction syndrome is common. The mortality rate in the intensive care unit (ICU) ranges from 40% to 50%. It may exceed 50% in the presence of septic shock. Pathophysi-ologically, bone marrow suppression, mucosal barrier injury, and impaired phagocytosis/cytokine responses play central roles. Risk stratification relies on several tools, including the Multinational Association for Supportive Care in Cancer score, the Clinical Index of Stable Febrile Neutropenia score, and the Sequential Organ Failure Assessment (SOFA) score. In the ICU, this assessment is further supported by monitoring lactate levels, changes in mental status, and various biomarkers such as procalcitonin, presepsin, and galactomannan. The “golden hour” principle highlights the importance of obtaining cultures and starting empiric antibiotics within 60 minutes of fever onset, which significantly reduces mortality. High-risk patients are initially treated with broad-spectrum monotherapy, such as piperacillin-tazobactam, meropenem, or cefepime. For those experiencing he-modynamic instability or infections with resistant gram-negative agents, combination therapy with aminoglycosides or colistin is recommended. For catheter-related infections or severe mucositis, treatments effective against resistant gram-positive bacteria (e.g. vancomycin, linezolid) should be added. If fever persists for more than 4-7 days, empirical antifungal treatment (echinocandins or voriconazole) should be initiated. ICU management includes early goal-directed fluid resuscitation, norepinephrine as the first-line vasopressor, lung-protective ventilation, granulocyte colony-stim-ulating factor administration, transfusion support, and nutrition. Poor prognostic factors include prolonged neutropenia (ANC <100/mm³ for more than 7 days), thrombocytopenia, lactate levels
>2 mmol/L, a SOFA score >5, and delays in antibiotic administration. In summary, febrile neutro-penia necessitates prompt diagnosis, aggressive antimicrobial treatment, and comprehensive organ support within a multidisciplinary approach. Emerging biomarkers and artificial intelligence-based predictive models show promise for enhancing risk stratification and personalised management in critically ill patients.