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28 Cards in this Set

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causes of increased gram positive bacteremia in neutropenic patients (4)
-indwelling IV catheters
-increased rates of mucositis
-less gram + empiric coverage
-prophylaxis w/ antimicrobias providing gram + coverage
most frequently occurring leukocyte; number of days for production and differentation in bone marrow; avg time in circulation; turnover
neutrophil;14d;6-12hr;BID
fever definition
oral temp of >101F or 100.4F >= 1hr
normal range neutrophils
1,800-7800 neutrophils/mm3
ANC formulas (2)
- WBC x [(%segs/100) + (%bands/100)]

- WBC x (%neutrophil/100)

WBC x 10^3
mild; moderate; severe ANC's
<1000/mm3; <=500/mm3; <100/mm3
what diseases affect neutrophil phagocytic function increasing risk of infection?
leukemia, lymphoma
low risk stratification (5)
-ANC >=100
-neutropenia <=7d
-neutropenia resolution w/in 10d
-normal chest radiograph
-peak temp <102F
signs of infection in a neutropenic patient
-fever
-pain at IV sites
neutropenic patient baseline workup (7)
-CXR
-BMP
-CBC w/ differential
-LFTs
-urinalysis w/ culture
-physical exam
->=2 blood samples for culture from different sites
gram + pathogens (5)
-staph aureus
-strep viridans
-enterococcus
-corynebacterium
-bacillus
gram - pathogens (6)
-pseudomonas
-klebsiella
-e.coli
-enterobacter
-proteus
-stenotrophomonas
when to start antibiotics (2)
-onset of fever
-if patient is afebrile w/ ANC <=500 (or 1000 and trending down) presenting w/ s/sx of infection
outpatient empiric therapy
cipro AND augmentin
inpatient empiric therapy
-cefepime OR ceftazidime OR a carbapenem

-aminoglycoside AND antipseudomonal penicillin OR ceftazidime OR cefepime OR a carbapenem
When should vancomycin empirically be used
-strep viridans suspected
-catheter related infection
-+ culture w/ a gram + pathogen but before sus. test
-MRSA
-hypotension/cardiovasular impairment
-mucosal damage from chemo
-progression to infection from previously classified low risk or previous px w/ a FQ
afebrile w/in 3 days of tx
-tailor therapy to pathogen if identified
-cont antib x7d t prevent breakthrough infection, until - cultures, sites of infection resolved, and pt is free from s/sx x7d
-preferable to have ANC >500 b4 discontinuing antibiotics
febrile >3d
-consider non-bacterial infection, resistance, slow response, 2nd infection, drug fever, avascular infection
-pt may be fine, avg defervescence may take 5d
-reassess pt w/ CXR, organ imaging, etc
when should empiric antifungal therapy be started?
initiate at 5-7d if patient continues to be febrile and severely neutropenic despite treatment w/ broad spectrum antibiotics
duration of antifungal therapy
continue for 14d in absence of infections s/sx
gold standard antifungal therapy
amphoterecin B 0.5-1mg/kg/d
amphoterecin B adverse effects
-nephrotoxicity
-infusion related reactions
-breakthrough fungal infections
fluconazole indications
-used only at institutions w/o drug resistant candida spp.
fluconazole cannot be used in patients with: (2)
-suspected aspergillus infection
-BMT pts who received px w/ fluconazole
what is the single most important determinant of antibiotic discontinuation?
neutrophil count
when can theraptay be d/c
generraly when ANC >500 x2d if no infectious lesions are identified despite continued febrile state
-continue antibiotics if pt has ANC <100 OR lesions on mucous membranes/GI tract OR unstable vital signs
when is prophylaxis warranted?
against pnemocystis jerovecii in some neutropenic pts, such as those w/ hematologic malignancies due to additional risk of cell phagocytic defects
health care precautions (5)
-reverse isolation
-hand washing
-avoid fresh fruits and vegetables
-laminar flow hoods to filter air away from pt
-well cooked food