Diagnostic evaluation of fever and neutropenia

• Exam: skin, oropharynx, lung, perirectal area, surgical & catheter sites; avoid rectal exam
• Studies: U/A, blood (periph & through each indwelling catheter port), urine, & sputum cx; for localizing s/s → ✓ stool (C. diff, cx), peritoneal fluid, CSF (rare source)
• Imaging: CXR; for localizing s/s → CNS, sinus, chest or abdomen/pelvis CT
• Caveats: neutropenia → impaired inflammatory response → exam and radiographic findings may be subtle; absence of neutrophils by Gram stain does not r/o infection