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28 Cards in this Set
- Front
- Back
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causes of increased gram positive bacteremia in neutropenic patients (4)
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-indwelling IV catheters
-increased rates of mucositis -less gram + empiric coverage -prophylaxis w/ antimicrobias providing gram + coverage |
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most frequently occurring leukocyte; number of days for production and differentation in bone marrow; avg time in circulation; turnover
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neutrophil;14d;6-12hr;BID
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fever definition
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oral temp of >101F or 100.4F >= 1hr
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normal range neutrophils
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1,800-7800 neutrophils/mm3
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ANC formulas (2)
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- WBC x [(%segs/100) + (%bands/100)]
- WBC x (%neutrophil/100) WBC x 10^3 |
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mild; moderate; severe ANC's
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<1000/mm3; <=500/mm3; <100/mm3
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what diseases affect neutrophil phagocytic function increasing risk of infection?
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leukemia, lymphoma
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low risk stratification (5)
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-ANC >=100
-neutropenia <=7d -neutropenia resolution w/in 10d -normal chest radiograph -peak temp <102F |
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signs of infection in a neutropenic patient
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-fever
-pain at IV sites |
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neutropenic patient baseline workup (7)
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-CXR
-BMP -CBC w/ differential -LFTs -urinalysis w/ culture -physical exam ->=2 blood samples for culture from different sites |
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gram + pathogens (5)
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-staph aureus
-strep viridans -enterococcus -corynebacterium -bacillus |
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gram - pathogens (6)
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-pseudomonas
-klebsiella -e.coli -enterobacter -proteus -stenotrophomonas |
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when to start antibiotics (2)
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-onset of fever
-if patient is afebrile w/ ANC <=500 (or 1000 and trending down) presenting w/ s/sx of infection |
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outpatient empiric therapy
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cipro AND augmentin
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inpatient empiric therapy
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-cefepime OR ceftazidime OR a carbapenem
-aminoglycoside AND antipseudomonal penicillin OR ceftazidime OR cefepime OR a carbapenem |
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When should vancomycin empirically be used
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-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 |
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afebrile w/in 3 days of tx
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-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 |
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febrile >3d
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-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 |
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when should empiric antifungal therapy be started?
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initiate at 5-7d if patient continues to be febrile and severely neutropenic despite treatment w/ broad spectrum antibiotics
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duration of antifungal therapy
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continue for 14d in absence of infections s/sx
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gold standard antifungal therapy
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amphoterecin B 0.5-1mg/kg/d
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amphoterecin B adverse effects
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-nephrotoxicity
-infusion related reactions -breakthrough fungal infections |
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fluconazole indications
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-used only at institutions w/o drug resistant candida spp.
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fluconazole cannot be used in patients with: (2)
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-suspected aspergillus infection
-BMT pts who received px w/ fluconazole |
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what is the single most important determinant of antibiotic discontinuation?
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neutrophil count
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when can theraptay be d/c
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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 |
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when is prophylaxis warranted?
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against pnemocystis jerovecii in some neutropenic pts, such as those w/ hematologic malignancies due to additional risk of cell phagocytic defects
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health care precautions (5)
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-reverse isolation
-hand washing -avoid fresh fruits and vegetables -laminar flow hoods to filter air away from pt -well cooked food |
