From the Guidelines
Patients with neutropenic fever should not have their temperature checked rectally. This is due to the risk of introducing bacteria through the rectal mucosa, which could lead to life-threatening infections in these immunocompromised individuals 1. Neutropenic patients typically have neutrophil counts below 500 cells/mm³, making them highly susceptible to infections. Instead, oral, tympanic, temporal artery, or axillary temperature measurements should be used for these patients. These alternative methods provide adequate temperature assessment without the risks associated with rectal measurement. The rectal route should be avoided because neutropenia compromises the body's primary defense against bacterial invasion, and the rectum naturally harbors numerous bacteria that could cause bacteremia if the mucosa is damaged during temperature measurement. Some key points to consider when measuring temperature in neutropenic patients include:
- The most accurate methods for measuring core body temperature are intravascular, esophageal, or bladder thermistors, but these may not always be available or practical 1.
- Rectal temperature measurements are not recommended for neutropenic patients due to the risk of infection and should be avoided 1.
- Oral temperature measurements are safe and convenient for alert and cooperative patients, but may not be accurate in patients who are intubated or unable to cooperate 1. Healthcare providers should document this contraindication in the patient's chart and ensure all staff are aware of the appropriate temperature measurement methods for neutropenic patients.
From the Research
Rectal Temperature Measurement in Neutropenic Fever
- The study 2 found that rectal temperature measurement was not associated with bacteremia in patients with neutropenic fever, and in-hospital mortality was similar between patients who had rectal temperature measurements and those who did not.
- The results of this study suggest that avoiding rectal thermometry may not be necessary in patients with neutropenic fever, as it does not appear to increase the risk of bacteremia.
- However, it is essential to note that the study's recommendation to avoid rectal thermometry is based on only a few studies, and more research may be needed to confirm these findings.
Management of Neutropenic Fever
- The management of neutropenic fever typically involves prompt, empiric antibiotic therapy, as stated in the study 3.
- The study 4 found that cefepime monotherapy was effective in treating febrile neutropenia, with a response rate of 61% in evaluable episodes.
- Another study 5 also found that cefepime monotherapy was effective as an initial, empirical treatment of febrile neutropenia, with a protocol success rate of 91.7%.
Considerations for Rectal Temperature Measurement
- While the study 2 did not find an association between rectal temperature measurement and bacteremia, it is crucial to consider the potential risks and benefits of rectal thermometry in patients with neutropenic fever.
- The study 6 highlights the importance of monitoring for adverse effects, such as neutropenia, in patients receiving antibiotic therapy.
- Overall, the decision to use rectal temperature measurement in patients with neutropenic fever should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history.