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42 Cards in this Set
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Clinical Signs of Infection:
Respiratory |
Cough
Purulence (Pus) Sputum Production Hyperventilation |
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Clinical Signs of Infection:
Urinary |
Pyuria (WBC's)
Frequency |
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Clinical Signs of Infection:
Systemic |
Fever / Chills
Hypotension Hypothermia |
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Clinical Signs of Infection:
Neurologic |
Mental Status Changes
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Clinical Signs of Infection:
Skin |
Erythemia (redness)
Pustulation Lesions |
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ANC Calculation
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ANC = WBC x [bands/100 + segs/100]
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DEFN: Neutropenic Fever
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ANC < 500 cells/mm3
Fever 38.3C / 101F or > 1hr 38C / 100.4F |
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Diagnosis and Workup
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Physical exam
2 blood cultures Chest Xray Cultures (urine,stool,skin lesions, sputum) |
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Pathogens Gram +
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MRSA = Meth resist. S. Aureus
MSSA = Meth suseptible S. Epidermidis |
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Pathogens Gram -
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E. coli
H. Influenzae Klebsiella Pseudomonas Enterococcus Fecalis |
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Pathogens Yeast
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Candida Albicans
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Pathogens Fungi
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Aspergillus
Crypto Histo |
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Prevention of Infections:
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isolaton
Gut decontamination hand washing avoid invasive procedures avoid fruits, vegs, plants, flowers, smoking |
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Prevention of Infections:
Anti-microbial prophylaxis |
Cipro 500-750mg po bid
decreases incidence of gram (-) |
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Prevention of Infections:
Antifungal Prophylaxis |
Fluconazole 400mg po qd in BMT pts
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Prevention of Infections:
Viral Infections |
1) Varicella-Zoster seronegative should avoid others with primary or secondary infxn
2) CMV seronegative to receive seronegative blood |
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Treatment:
Penicillin + Aminoglycoside |
Pipercillin 4g q6h
Gentamicin 2mg/kg loading followed by maintenance dose determined by serum conc. |
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Treatment:
Antiseudomonal Cephalosporine + Aminoglycoside |
(Cefepime 1-2g q12h
or Ceftazidime 1-2g q8h) + Gentamicin 2mg/kg loading followed by maintenance dose determined by serum conc. |
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Treatment:
Aminoglycoside + Quinolone |
Ciprofloxacin 0.4g q 8-12h
+ Gentamicin 2mg/kg loading followed by maintenance dose determined by serum conc. |
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Treatment:
Monotherapy |
Cefepime 1-2g q12h
Ceftazidime 1-2g q8h Piperacillin/tazobactam 4.5g q6h Imipenem/cilastatin 0.5g q6h Meropenem 1g q8h |
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Antifungal Therapy
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Vorconazole 400mg BID x 2 doses, then 200mg BID
IV: 6mg/kg q12h x 2 doses then 3mg/kg q12h |
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Vorconazole Concerns
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Cyclodextran in formulation is toxic with CrCl < 50ml/min
Drug-Drug interactions Visual Disturbances with IV dosing |
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Vorconazole Plus's
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Decreased SE's
Superiority to emperic Amphotericin B |
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Amphotericin B therapy:
Esophageal Candidiasis |
0.5 mg/kg/day
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Amphotericin B therapy:
Disseminated Candidiasis |
0.5 - 1 mg/kg/day
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Amphotericin B therapy:
Aspergillosis |
1.5 mg/kg/day
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Amphotericin B therapy:
Lifetime dose |
4 grams (regular product)
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Amphotericin B therapy:
Infusion related / acute effects |
Fever, Chills, Nausea, Vomiting
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Amphotericin B therapy:
Chronic Effects |
Nephrotoxicity
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Amphotericin B therapy:
Infusion related / acute effects TREATMENT |
APAP 650-1000mg po/pr 30min prior
(Avoid NSAIDS b/c increased bleeding effects) Hydrocortisone for rigors 25-50 mg iv 30 min prior (reasses q3-7 days) Benadryl ....DOSE??..... Meperidine 25mg IV q15 min prn rigors up to 100mg over 1 hr caution renal insufficiency |
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Amphotericin B therapy:
Nephrotoxicity TREATMENT |
Limit cumulative dose
Hydration and high sodium diet 1L NS qd (NOT Dextrose) Liposomal formulations with reduced nephrotoxicity |
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Amphotericin B therapy:
Electrolyte problems |
Mg / K wasting
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Oral Antifungal Agents:
Nystatin for Thrush |
100,000U/ml 5ml swish and swallow QID x 7-10 days
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Oral Antifungal Agents:
Clotrimazole for Thrush |
10mg Troche 15 - 20 min for slow dissolution 4-5x/day x 7-14 days
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Oral Antifungal Agents:
Fluconazole for Thrush |
100 mg tab po qd x 7-14 days
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Oral Antifungal Agents:
Fluconazole for Esophogeal Candidiasis |
200 mg qd x 14 - 21 days
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Fever & Neutropenia:
Route of Initial Therapy |
High Risk IV AB's
Low Risk IV or PO |
IV vs PO
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Fever & Neutropenia:
Initial Therapy Drug Therapy |
If pt. qualifies for vanco, begin 2-3 drug combo with vaco.
(cefepime, ceftrazidime etc. with aminoglycoside) |
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Fever & Neutropenia:
Persistent Fever 48-72 hrs |
A) If no Change in pt condition consider stopping Vanco and continue with inital ab's
B) Progressive dx: Change ab's add vanco if required C) Febrile days 5-7 but resolution of neutropenia iminent: use ANTIFUNGAL with/without AB change |
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Fever & Neutropenia:
Persistent Fever 48-72 hrs |
OK wait 5 days to make changes unless clinical deterioration or culture results.
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Fever & Neutropenia:
Persistent Fever 7 days |
Contiunue Therapy with init. AB's
Change or add AB's Add antifungal with/without changing antibiotics |
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Aminoglycoside Benefits
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Concentration killing
Synergy with other antibiotics |
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