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26 Cards in this Set
- Front
- Back
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Definition of Febrile
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Single temp 38.3 C (101F) or greater.
Temperaure 38 C (100.4F) or greater over an hour |
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The Five "W's" - To determine cause of fever
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Wind (Pulmonary Infection)
Wound (Abscess, cellulitis) Whiz (UTI, genitourinary) Walk (DVT, PE) Wonder drugs (antieleptics, antibiotics) |
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Definition of Neutropenia
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Absolute neutrophil count (ANC) 500 or less cells/mm3 of
ANC 1000 or less cells/mm3 and predicted to decline to 500 or less cells/mm3 over next 48 hours |
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Types of Neutropenia
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Mild: ANC <1500
Moderate: <999 Severe: <500 Profound <100 |
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Calculate ANC
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ANC = (% segs + % bands)/100 x WBC
Normal ANC 2000 or greater |
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Common Bacterial Gram Positive Pathogens
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Staph. aureus (including MRSA)
Coagulase-negative staph Viridans group streptococci Enterococcus spp Strep pneumo, strep pyogenes |
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Common Bacterial Gram Negative Pathogens
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E.Coli
Klebsiella spp Enterobacter spp Pseudomonas aeruginosa Citrobacter spp Acinetobacter spp Stenotrophomonas maltophilia |
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Atypical Bacteria Pathogens
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Legionella spp
Mycoplasma spp Chlamydia spp |
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Anerobe Bacteria Pathogens
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Clostridium difficile
Bacteriodes spp |
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Common Fungi Pathogens
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Candida spp (Albicans > Non-Albicans - yeasts)
Aspergillus spp and Zygomycosis (molds) |
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Common Viral Pathogens
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Herpes simplex
Varicella zoster Cytomegalovirus (CMV) |
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Common Opportunistic Pathogens
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Pneumocystis jiroveci (PCP)
Occurs in prolonged neutropenia >1 month; more often in HSCT and ALL |
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General Principles of Treatment
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1. Reduce chemotherapy
2. Infection control 3. Cultures x 2 (one from CVC) - if time to positivity >120 min difference suggest central line infection 4. Blood-spectrum antibiotics - start ABX within 1 hour of blood cultures being drawn); use aggressive dosing 5. History and physical |
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Risk stratification - Low risk
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1. Outpatient status at time of development
2. No comorbid illnesses 3. Anticipated short duration of severe neutropenia 4. Good performance status 5. No hepatic or renal insufficiency (Found most commonly among pts with solid tumors receiving chemotherapy) |
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Risk stratification - High risk
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1. Profound neutropenia (ANC <100) anticipated to extend for more than 7 days
2. Presence of any co-morbid medical problems (including GI upset) 3. Hepatic or renal insufficieny |
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Risk stratification - MASCC
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Score 21 or greater is low risk
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Oral Therapy - Preferred Regimen
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Big doses: Ciprofloxacin 500-750 mg PO BID + Augmentin 500 mg PO Q8H
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IV Monotherapy - Preferred Regimen
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Antipseudomonal beta-lactam
-Ceftazidime, Cefepime -Carbapenems (except ertapenem) -Zosyn 4.5 gm |
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IV Dual Therapy - Preferred Regimen
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Antipseudomonal beta-lactam + AG
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When do you add Vanco?
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1. Catheter related infections suspected
2. Blood cultures with gram (+) organisms pending 3. Known colonization with MRSA 4. Hypotension or shock without identifiable cause 5. Soft tissue infection (D/C 2-3 days if no MRSA) |
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Reassessment of Empiric Antibiotic Therapy
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2-4 days
If responding, continue ABX for 7-14 day course as appropriate for documented infection or until ANC >500 and rising. |
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When to Add Empiric Antifungal Therapy?
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After day 4-7 if appropriate broad spectrum antibiotics were used and pt still febrile.
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What Antifungal Agents to use as Empiric Antifungal Therapy?
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Voriconazole - DOC for Aspergillus spp
Caspofungin Ampho B |
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Febrile Neutropenia Prophylaxis - Antibacterial
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Recommended for high risk pts only
Bactrim Quinolones for high risk pts - Cipro or levo |
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Febrile Neutropenia Prophylaxis - Antifungal
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Azoles - Fluconasole, posaconazole, voriconazole
Enchinocandins - micafungin Ampho B - 2nd line |
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Colony Stimulating Factor
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Filgrastim and Pegfilgrastim
Only recommended for high risk pts Used to stimulate the immune system function; Also used for prophylaxis in the prevention of neutropenia Do not start until 24 hours after last chemo dose |
