A case of febrile neutropenia

Question 1

Febrile neutropenia

Answer 1

• Can be caused by chemo?
• Common in severely neutropenic patients
• High rates of bactaraemia
• Infections from endogenous gut and skin (through catheter?) flora
• Very high mortality in patients with gram- bacteria
• Improved outcome with empiric antibiotic use

Question 2

Rigors

Answer 2

Uncontrolled prolonged shivering, often in severe infection

Question 3

Risk on infection if neutrophils <0.1

NOTE not all cancer treatments will cause it this bad, common in haematologic cancer treatment

Answer 3

Duration of 1 week- 33% severe infection

Duration of 6 weeks- 100% severe infection

Question 4

Common infectiou agents in febrile neutropenia

Answer 4

Gram + staphylococci and streptococci.

Aerobic gram -ve bacilli (E. Coli, Pseudomonas aeruginosa)

Question 5

Empiric antibiotic regiment, before known organism

Answer 5

Tazocin (piperacillin and tazobactam): Active against almost all aerobic bacteria
+
Gentamicin (aminoglycoside): active against almost all aerobic gram -ve bacilli

Question 6

Ideas to reduce conseqeunces of febrile neutropenia?

Answer 6

Antibiotic prophylaxis- controversial
Haematopoietic growth factors such as G-CSF
Nurse patients in isolation
Reduced intensity of chemo