Pathophysiology and management of neutropenia in the critically ill

Abstract Neutropenia is defined by an absolute neutrophil count <500 per mm3. Chemotherapy-induced myelosuppression represents the main mechanism accounting for neutropenia, although various bone marrow disorders might also result in impaired granulopoiesis. Neutropenia, especially when profound and prolonged, is a major risk factor for severe bacterial and fungal infections. Early initiation of empirical broad-spectrum antibiotic therapy represents the cornerstone of the treatment of febrile neutropenia. A number of infected neutropenic patients may exhibit organ failures, such as acute respiratory failures and/or severe sepsis requiring intensive care unit (ICU) admission. This chapter discusses the particularities in the management of neutropenic patients in the ICU, including outcome and criteria for ICU admission, management of antimicrobials with respect to the current epidemiological trends, and other measures specific to this subgroup of patients.