Final answer:
The appropriate management for a febrile neutropenic patient includes obtaining blood and urine cultures followed by immediate commencement of broad-spectrum antibiotics. Vancomycin and cefepime offer coverage against the common pathogens in such immunocompromised individuals. Timely antimicrobial therapy is critical to prevent rapid and possibly fatal deterioration.
Step-by-step explanation:
The management of a febrile neutropenic patient, such as the 43-year-old woman described, should follow established guidelines that prioritize immediate empiric antibiotic therapy. Neutropenia is defined as an absolute neutrophil count (ANC) below 500/mm³ or expected to fall below 500/mm³. A fever in a neutropenic patient is a medical emergency because it may be the only sign of an underlying infection. The presence of a mediport and the history of breast cancer on chemotherapy additionally suggest an immunocompromised state, increasing the risk of severe infections, including those that are hospital-acquired or resistant to standard antibiotics.
Option 3, "Send blood and urine cultures and start vancomycin and cefepime," is the most appropriate initial management step because it involves both diagnostic and therapeutic measures. Blood and urine cultures should be taken immediately before initiating antibiotics, and broad-spectrum antibiotics should be started without delay. Vancomycin is a glycopeptide antibiotic that covers gram-positive bacteria, including MRSA, and cefepime is a fourth-generation cephalosporin with a broad range of activity against gram-negative bacteria, making this combination appropriate for broad empiric coverage pending culture results.
Although initiating filgrastim, a granulocyte colony-stimulating factor, may be indicated to elevate the ANC, immediate discharge home would not be appropriate given the risk for rapid deterioration. While awaiting blood culture results before treatment may prevent overtreatment, it delays necessary therapy and increases morbidity and mortality risks in febrile neutropenia. Levofloxacin with admission could be considered but may not provide sufficient coverage for potential pathogens in an immunocompromised host.
The final answer is that the patient should be sent for blood and urine cultures and started on vancomycin and cefepime because these actions provide both immediate broad-spectrum antibiotic coverage and diagnostic information to guide further treatment, which is crucial in managing febrile neutropenia.