A cancer patient with fever and neutropenia. What is the priority action?

• A. Withhold antibiotics until culture results are known.
• B. Administer broad-spectrum antibiotics promptly after cultures; monitor for sepsis.
• C. Administer antifungal therapy first.
• D. Obtain imaging before any treatment.

Answer: (B)

In cancer patients who are neutropenic, the body's defense against infections is severely impaired, so fever can be the first and most important sign of a rapidly spreading bacterial infection. Neutropenia means the infection can advance quickly to sepsis with little warning, making time a critical factor. The priority is to start empiric broad-spectrum IV antibiotics promptly after drawing cultures, so you cover a wide range of likely pathogens (including Pseudomonas) without waiting for exact culture results. Cultures should be obtained first if possible, but treatment should not be delayed while waiting for results. After starting therapy, monitor closely for signs of sepsis and adjust the regimen based on culture data and the patient's clinical status. Antifungal therapy is not the initial step unless fever persists or risk factors for fungal infection are present, and imaging is important for locating an infection source but does not take precedence over starting antibiotics.