Study objectivesThe primary objective was to describe the management of patients with febrile neutropenia in EDs and to determine whether management complies with recommendations. 17-AAG buy The secondary objective was to determine the factors associated with adequate management.Evaluation criteria in the guidelines were identified to accurately assess the primary end points. Patients with febrile neutropenia were divided into two groups: those with and those without severe sepsis or septic shock (SS/SSh).Patients with SS/SSh were selected according to the following criteria [9,17]: blood lactate more than 4 mmol/L, or low blood pressure before fluid challenge (systolic blood pressure <90 mmHg or 40 mmHg below usual systolic blood pressure), or at least one organ dysfunction (pulse oxymetry [SpO2] <95% with fraction of inspired oxygen >0.

5, blood creatinine >176 ��mol/L or oliguria, international normalised ratio >2, bilirubinemia >78 ��mol/L, Glasgow Coma Scale <15). Thrombopenia was excluded from the criteria because of the potential effect of chemotherapy on platelet counts. Patients without SS/SSh were identified as high risk or low risk according to the MASCC classification [6] (Table (Table1).1). Of note, data that allowed determination of MASCC and presence of SS/SSh were collected at the bedside by attending physicians. Implementation of the database was not intended to help physicians detecting the severity of a patient's condition.Table 1Classification according to the Multinational Association for Supportive Care in Cancer(MASCC) [6]Implementation of the following guidelines was assessed.

Management of patients with SS/SSh required for the 90 first minutes [9,10]: (i) a dose regimen of adequate (broad-spectrum) intravenous antimicrobial therapy; (ii) fluid challenge (500 mL) if mean arterial blood pressure was less than 65 mmHg; (iii) lactate measurement; (iv) AV-951 at least one blood culture; and (v) hospitalization. Management of patients without SS/SSh who were high risk according to MASCC criteria required [18-20]: (i) adequate intravenous antimicrobial agent (broad-spectrum beta-lactam with or without an aminoglycoside); (ii) no initiation of granulocyte-cell stimulating factor (G-CSF); and (iii) hospitalization. Management of patients without SS/SSh who were low-risk according to MASCC criteria required [18-20]: (i) adequate oral antimicrobial agent (quinolone or amoxicillin/clavulanate or cephalosporin); (ii) no initiation of G-CSF; and (iii) hospital discharge.Patients were divided into two groups; those managed according to recommendations and those who were not, irrespective of initial severity. The two populations were compared to determine the factors associated with adequate management.