A 6-year-old girl is brought to the emergency department by her parents due to a sudden on… — USMLE Step 2 CK

A 6-year-old girl is brought to the emergency department by her parents due to a sudden onset of fever. She was diagnosed with acute lymphoblastic leukemia (ALL) six months ago and is currently undergoing maintenance chemotherapy. Her temperature is $39.4^\circ C$ ( $102.9^\circ F$ ), blood pressure is $90/55$ mmHg, and heart rate is $125$ /min. Physical examination reveals a pale, fatigued child with a central venous catheter in place. There is no erythema or discharge at the catheter site. Laboratory studies show an absolute neutrophil count (ANC) of $350/mm^3$ . Blood cultures are obtained. Which of the following is the most appropriate next step in management?

A
Administer the live-attenuated varicella vaccine to prevent viral co-infection.
B
Prescribe oral amoxicillin to align with antibiotic stewardship guidelines.
Initiate empiric broad-spectrum intravenous antibiotics immediately.Answer
D
Await blood culture results before initiating any antimicrobial therapy.
E
Administer nebulized bronchodilators for a presumed viral respiratory infection.

Answer

Initiate empiric broad-spectrum intravenous antibiotics immediately.

This patient has febrile neutropenia, clinically defined as a single oral temperature of

\geq 38.3^\circ C

(

101^\circ F

) or sustained temperature

\geq 38.0^\circ C

(

100.4^\circ F

) for

\geq 1

hour in the setting of an absolute neutrophil count (ANC) below

500/mm^3

. Because immunocompromised patients lack the white blood cells necessary to mount a standard inflammatory response, a bacterial infection can rapidly progress to life-threatening sepsis. Therefore, the immediate administration of empiric broad-spectrum intravenous antibiotics with antipseudomonal activity (such as cefepime, meropenem, or piperacillin-tazobactam) is the most critical next step immediately after obtaining blood cultures.

Step-by-Step Solution

Identify the primary clinical problem from the vignette.

The patient is a pediatric oncology patient on chemotherapy presenting with a fever (

39.4^\circ C

) and an absolute neutrophil count of

350/mm^3

Recognizing the combination of fever and severe neutropenia (ANC <

500/mm^3

) establishes the diagnosis of febrile neutropenia.

Determine the standard emergency management protocol for this condition.

Immediate administration of empiric broad-spectrum intravenous antibiotics.

Patients with severe neutropenia cannot mount an adequate cellular immune response. Delaying antimicrobial therapy can rapidly lead to overwhelming, fatal sepsis.

Key Concept

Febrile neutropenia is a medical emergency requiring immediate empiric broad-spectrum intravenous antibiotics (e.g., cefepime, piperacillin-tazobactam) after obtaining blood cultures.

Estimated Time:1m 0s

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