Optimising prevention of febrile neutropenia is therefore an important part of the management. Forty-seven (24%) patients were treated with G-CSF to prevent febrile neutropenia, whereas 174 (88%) had one or more risk factors that should have prompted http://www.selleckchem.com/products/Erlotinib-Hydrochloride.html the prophylactic use of G-CSF [24]. In our sample, there was an under-use of G-CSF in patients at risk of febrile neutropenia. The under-use of G-CSF in oncology practice was also reported previously by Hayes [25]. We therefore believe that emergency physicians will have increasing chances to treat febrile neutropenia.In their series used to derive and validate the Mortality in Emergency Department Sepsis (MEDS) score, Shapiro and colleagues reported that 35.5% and 2.5% of patients visiting the ED with infection had severe sepsis and septic shock, respectively [12].

Here we reported that 89 (45%) patients with febrile neutropenia presented with SS/SSh. This underscores that chemotherapy-related neutropenia in cancer patients is a risk factor for developing severe infection. In our series, very few patients that developed severe infections were treated according to current guidelines. Indeed, adequate management was initiated in only six patients. This may suggest that detecting severe infections is challenging for emergency physicians. Initial severity assessment is sometimes falsely reassuring and patients may worsen during their stay in the ED [26]. A study conducted in Brazil [14] reported that ED physicians were able to detect severe infection in 15.8% of cases. Implementation of the Surviving Sepsis Campaign guidelines improved detection of severe infections but 61.

5% of patients remained under-treated because of inadequate assessment. Measuring lactate concentration has been recommended to help physicians detect [26] and manage severe infections [27]. We observed that lactate was infrequently measured in the present series. Therefore, procedures to optimise detection of severe infection were partially applied in our patients that did not seem to be perceived as severely ill.A burden of evidence supports the paramount role of early recognition and prompt management of severe infection, and admission to the ICU when applicable [27]. The prognosis of patients with severe infection actually depends on their initial management; that is, treatment received in the ED for half of patients [28].

We observed that few patients received adequate antimicrobial therapy or fluid challenge in an appropriate time-span. We therefore conclude that patients with severe infection were under-treated. Similar findings were reported Batimastat in a large Spanish study [29], as an incredibly low rate of patients admitted with SS/SSh received process-of-care according to bundles, even after an educational program involving physicians and nurses of the ED and ICU.