Another important aspect of the patient is neutropenic fever

Any patient with
✓ one episode of oral temperature > 38.3 °C or
✓ more than one hour with oral temperature > 38°C or
✓ positive SIRS in patients receiving steroids as chemotherapy regimen
AND
Absolute neutrophil count (ANC) (PMN + band cell number) less than 1500

Should be considered as neutropenic fever, which is one of the most important oncologic emergencies.

Early studies of patients with neutropenic fever documented mortality rates of up to 70 percent if initiation of antibiotics was delayed. So we have to start empiric antibiotic therapy within 30 mins of patient admission.

Based on the Up-to-date algorithm for neutropenic fever management, in patients with severe end organ damage (like our patient with renal failure and altered mental status) it is better to use a broad spectrum antibiotic with anti pseudomonas activity (like Meropenem) and a second anti pseudomonas agent (like ciprofloxacin) plus anti MRSA antibiotic (like vancomycin).

However, some references like Harrison 2022 disagrees with the combination antibiotic regimen for gram negative coverage (so if you have chosen Meropenem + vancomycin regimen in the test you are not somehow wrong 😉).