Complications
Use of broad-spectrum antibiotics can result in fungal overgrowth, which can present with either persistent or recurrent fever despite broad-spectrum antibiotics. Persistent or recurrent fever while on antibiotics should prompt fungal cultures and serological testing along with computerised tomography imaging and consideration of empirical treatment with antifungal agents.
Mortality from febrile neutropenia has decreased to less than 10% among high-risk patients who receive antibiotics promptly.[12]
Mortality in low-risk patients is 1% to 2%.[77]
Mortality risk is higher in patients who present with hypotension and documented bloodstream infection (as high as 24% to 82%).[92][93][94] It is also increased in patients with pneumonia, uncontrolled cancer, polymicrobial infections, and older age.[95][96][97]
Use of broad-spectrum antibiotics can result in the development of C difficile colitis, which can be transient or can become an ongoing problem in the face of repeated immunosuppression. It should be suspected in patients receiving antibiotics or who have a history of antibiotic exposure who present with voluminous diarrhoea associated with crampy abdominal pain, fever, and leukocytosis.
Use of empirical broad-spectrum antibiotics can result in colonisation and/or infection with multi-drug-resistant organisms (MRSA, vancomycin-resistant enterococci, extended-spectrum beta-lactamase producers, carbapenem-resistant Enterobacterales). Multidrug-resistant infections should be suspected if a patient has recurrent or persistent fever on antibiotics. Cultures with susceptibility data are the gold standard for diagnosis.
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