Cancer Care Infections

Question 1

Cancer Care: Choice of Antibiotics depends on

Answer 1

• Site of infection
• Potential organisms involved
• Severity of infection and/or risk of rapid progression
• Spectrum of different antibiotics
• Known colonising flora - patient or environment
• Any organ dysfunction- renal, hepatic
• Any allergies

Question 2

Cancer Care: How do we classify Organisms?

Answer 2

• Gram positive – Staph/ Strep/ Pneumo
• Gram negative – Coliforms/ Pseudomonas
• Aerobic/ anaerobic
• Resistant organisms – MRSA/ ESBL/ VRE, Other resistant
gram negatives
• Atypical organisms
• C.difficile
• Fungal
• Mycobacteria

Question 3

Cancer Care: Hospital superbugs

Answer 3

• MRSA
• Clostridium difficile
• Multi-resistant gram-negatives
• ESBL producers
• Multi-resistant Acinetobacter
• Multi-resistant Pseudomonas
• Carbapenemase producing enterobacteriaceae(CPE)

• Other potential threats

• MDR-TB
• VHF

Question 4

Cancer Care: Community superbugs

Answer 4

• CA-MRSA
• PVL Staphylococcus aureus
• ESBL gram negatives

Question 5

Cancer Care: Drug of choice for MSSA

Answer 5

DOC: Flucloxacillin

Alternative: Erythromycin, Cefuroxime, Teicoplanin/Vancomycin, Doxycycline

Question 6

Cancer Care: Drug of choice for MRSA

Answer 6

DOC: Teicoplanin / Vancomycin

Alternatives: Daptomycin, Linezolid

Question 7

Cancer Care: Drug of choice for Streptococci

Answer 7

DOC: Benpen, Amoxycillin

Alternatives: Erythromycin, Doxycycline, Cefuroxime, Teic/Vanc

Question 8

Cancer Care: Drug of choice for Enterococci

Answer 8

DOC: Amoxycillin

Alternatives: Teic/Vanc, Linezolid

Question 9

Cancer Care: Drug of choice for Coliforms

Answer 9

DOC: Amoxycillin, Co-amoxiclav, Gentamicin

Alternatives: Tazocin, Cephalosporin, Imipenem, Ciprofloxacin

Question 10

Cancer Care: Drug of choice for ESBLs

Answer 10

DOC: Imipenem

Alternatives: based on sensitivities

Question 11

Cancer Care: Drug of choice for Pseudomonas

Answer 11

DOC: Tazocin, Gentamicin

Alternatives: Imipenem, Ceftazidime, Ciproflxacin

Question 12

Cancer Care: Drug of choice for C Difficile

Answer 12

DOC: Metronidazole / Vancomycin orally

Question 13

Cancer Care: Drug of choice for Atypical pneumonia

Answer 13

DOC: Erythro/clarithromycin

Alternatives: Doxycycline, Ciprofloxacin

Question 14

Cancer Care: coverage of amoxycillin

Answer 14

GP: Streptococci, Pneumo, Enterococci

GN: Coliforms

Other: Some anaerobes

Question 15

Cancer Care: coverage of Co-amoxiclav

Answer 15

GP: Streptococci, Pneumo, Enterococci, Staphylococci

GN: Coliforms including BL producers

Other: Anaerobic

Question 16

Cancer Care: coverage of Flucloxacillin

Answer 16

GP: Staphylococci

GN:

Other:

Question 17

Cancer Care: coverage of Tazocin

Answer 17

GP: Same as Co-amoxiclav (Streptococci, Pneumo, Enterococci, Staphylococci)

GN: Coliforms including BL producers, Pseudomonas

Other: Same as Co-amoxiclav (Anaerobic)

Question 18

Cancer Care: coverage of Erythromycin

Answer 18

GP: Streptococci, Pneumo, Staphylococci

GN:

Other:

Question 19

Cancer Care: coverage of Gentamicin

Answer 19

GP: Streptococci, Pneumo, Staphylococci
- Synergistic activity

GN: Coliforms including BL producers, Pseudomonas

Other:

Question 20

Cancer Care: coverage of Cefuroxime

Answer 20

GP: Streptococci, Pneumo, Staphylococci

GN: Coliforms

Other:

Question 21

Cancer Care: coverage of Ceftriaxone

Answer 21

GP: Streptococci, Pneumo, Staphylococci

GN: Coliforms

Other:

Question 22

Cancer Care: coverage of Ceftazidime

Answer 22

GP:

GN: Coliforms, Pseudomonas

Other:

Question 23

Cancer Care: coverage of Imipenem

Answer 23

GP: Streptococci, Pneumo, Enterococci, Staphylococci

GN: Coliforms including ESBL producers, Pseudomonas

Other: Some anaerobes

Question 24

Cancer Care: coverage of Ciprofloxacin

Answer 24

GP: May have activity against Staphylococci

GN: Coliforms, Pseudomonas

Other: Atypical

Question 25

Cancer Care: coverage of Doxycycline | oral only

Answer 25

GP: Streptococci, Pneumococci, Staphylococci GN: Other: Atypical

Question 26

Cancer Care: Which antimicrobials require monitoring for toxicity?

Answer 26

* Aminoglycosides * Glycopeptides * Colistin * Others in special situations

Question 27

Immunocompromising conditions: Congenital conditions

Answer 27

* B-cell and T-cell defects * Macrophage, cytokine, and miscellaneous defects * Phagocyte deficiency or dysfunction * Complement deficiencies

Question 28

Immunocompromising conditions: Acquired conditions

Answer 28

* Malnutrition , Immunosenescence * HIV infection * Medical conditions : Cancer , Splenectomy, Pregnancy * Immunosuppressive drugs : Anti-cancer medication, Transplant

Question 29

neutropenic patients: Special risk sites

Answer 29

Ulcerated or damaged (by chemo/radio therapy) mucosal surfaces (mouth, whole GI tract) Vascular lines, especially semipermanent (Hickman catheters, Port-a-Caths, central lines) Empiric therapy must be started straight away (after collection of cultures)

Question 30

Most common organism associated with CVC infections

Answer 30

Staphylococcus epidermis, followed by Staphylococcus aureus. Gram- negative bacilli, fungi (Candida) and Mycobacteria are less common.

Question 31

Infection risks with monoclonal antibodies and ant-TNF

Answer 31

* Prior to commencing anti-TNF, all patients should be screened for mycobacterial infection, hepatitis B/C/HIV * High index of suspicion for atypical and opportunistic infections

Question 32

Pneumonias in | Immunocompromised

Answer 32

Bacterial Infection - CAP pathogens include S. pneumoniae, H.influenzae, Mycoplasma, Legionella, Chlamydia, and others. FungalInfection-Pneumocystisjirovecii,Aspergillus spp (especially A. fumigatus), and Cryptococcus neoformans. Viral Infection - Cytomegalovirus , Influenza, Parainfluenza, and Respiratory Syncytial virus Parasites - Strongyloides stercoralis and Toxoplasma