ANC 150, T 39.0°C — neutropenic fever criteria met.
- ANC
- 150 cells/µL
- Temperature
- 39.0 °C
- Systolic BP
- 122 mmHg
- Hemodynamically stable
- yes
- MDR history
- MRSA
- Indwelling catheter / line
- yes
Antibiotics
- β-lactam-1 · IV · X g every Y hours
- glycopeptide-1 · IV · X mg/kg loading dose, then trough-guided — selected for MRSA coverage
Cultures
- Blood cultures × 2 — one peripheral, one from each lumen of indwelling line
- Urinalysis with culture
Ancillary
- CBC with differential — repeat in 6 hours
- Comprehensive metabolic panel
- Lactate
Nursing
- Vital signs every 1 hour × 4 hours, then every 4 hours
- Reverse isolation precautions — neutropenic patient
Pharmacy
- Verify renal dosing on empiric antibiotics
- Cross-check empiric coverage against patient's MDR history — Documented colonization: MRSA
Decisions
- Trigger met: ANC 150 cells/mm³ (<500) and temperature 39.0°C (single ≥38.3°C).
- Risk stratification: high-risk inpatient IV pathway (v1 default for the simplified algorithm).
- Empiric antipseudomonal β-lactam-1 monotherapy with β-lactam-1.
- Recent MRSA colonization — added glycopeptide for gram-positive coverage. Additional indications: indwelling catheter.
- Catheter present — paired blood cultures (line and peripheral) to evaluate for line infection.
Out of scope
- Local antibiogram and unit-specific resistance patterns are not in the algorithm; consider when finalizing coverage.
- Pediatric dosing is not covered by this algorithm (adults only).
- MASCC scoring and full risk-stratification beyond hemodynamic stability are not implemented in v1.
Second opinion
Simulated colleague voice; class-level antibiotic names only. No real drug names are sent to the model.
Sign writes class-level antibiotics + "Neutropenic fever" problem. Override writes nothing.