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IOS 11 Exam 3
Febrile neutropenia
| Question | Answer |
|---|---|
| ANC is the | Absolute neutrophil count = % neutrophils x WBC count |
| Fever is defined as | A single oral temperature >38.3 (101) or 38.0 (100.4) than is sustained >1 hour |
| Neutropenia is defined as | ANC<500 or <1000 with predicted decline to <500 |
| Neutropenia with some risk | ANC<1000 |
| Neutropenia with significant degree of risk | ANC <500 |
| Profound neutropenia with extremely high risk | ANC <100 |
| Why we are fearful of febrile neutropenia | 50-60% or neutropeni patient are occult (+), risk of infection increase with increased duration of neutropenia, 20% of ANC <100=bacteremia, Bacteremia=3-4x mortality risks |
| Historical pathogens | Conversion from Gram (-) to Gram (+) and pseudomonas is still a threat |
| Pathogens most seen in neutropenia | Staph Aureus, S. Epidermis, S. pneumonia, S. pyrogenes, Stre Viridans, Ecoli, Klebsiella, enterobacter,serratia, candidia, aspergillis, HSV, zoster, CMV |
| Common sites of infection in febrile neutropenia | Oropharynx, Sinuses,urinary tract, skin, blood stream, catheters |
| Treatment of febrile neutropenia | Ceftazidine, cefepime, carbapentems, (+ aminoglycosides or pipercillin/tazobactam) use combination if Fluoroquinolone used previously or sepsis |
| Treament of Aspergillus in febrile neutropenia | Ampotercin B |
| If Fever resolves | ANC>500 at day 3-5 Stop antibiotics after 48 hour if <500 at day 7 and high risk continue PO consider swithing when afebrile |
| Febrile and no change in s/s | COntinue antibiotics |
| Febrile and progressive infection | Change antibiotics and add vanomycin |
| Febrile 5-7 days and resolution of neutropenia not expected (5-7 days) | Antifungal + canvomycin + change antibiotic |
| Nadir response | Lowest in 7-10 days and resolution in 1 week |
| Febrile and ANC>500 | Stop antibiotic 4-5 days after ANC>500 |
| ANC <500 and febrile | Continue antibiotic x 2-3 weeks |
| Patient at low risk are | Short duration of fever, neutropenia, negative blood culute, no organ dysfunction, ANC reached nadir, expected neutropenia<7 days, onset of fever/neutropenia <10 days |
| Conditions for effective outpatient management of febrile neutropenia | Low risk patient, reliable patient/care provider, effective antibiotics, close provider folow up, easy access to hopsital, 24 hour care provider available |
| Granulocyte stimulating factor is used for | adjunctive therapy (continue chemo), severe pronlinged ANC <500 x 7 days, Severe ANC<100 or sepsis, documented pneumomia or life threatening illness |
| Prevention of Febrile neutropenia and infections | Goen and mask visitors, no fruits and vegtables prior and during neutropenia, no flowers, strict infection control |
| Prophylaxis is | Recommended only for profound ANC<100 and prolonged -Bactrium and Fluoroquinones |
| Antifungal prophylaxis is | Recommended for acute leukemics, and BMT-Fluconazole, itraconazole or Ampotercin B |
| HSV prophylaxis | Recommended in acute leukemia- Acyclovir or Valcyclovir |
Created by:
liza001
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