Dilemmas and choices in infection management of the cancer patient.

Dilemmas related to fever and infection in the granulocytopenic cancer patient demand management choices frequently in the face of inadequate data to assure confidence in the decision taken. Key elements to decision-making include: recognition of the types of infections which tend to occur in these patients within one's own institution and the usual antimicrobial susceptibility patterns of the common pathogens within one's own institution. Second, one must differentiate the moderately granulocytopenic patient from one likely to have profound, persistent granulocytopenia and, hence, a high risk of mortality from gram-negative rod bacteremia. This information will assist in the selection of an initial empiric regimen. The same information in conjunction with the results of surveillance cultures and especially the results of repeat daily history and physical examination will assist in decisions related to discontinuation of the initial antibiotics, alterations in the original regimen, and decisions related to possible superinfections.