Exam 5 - Immunocompromised Host Flashcards
Neutropenia = an ________ less than _______/mm3
an ANC (absolute neutrophil count) less than 1000
how to find ANC?
WBC x (% polys + % bands)
what are important risk factors related to neutropenia
severity of neutropenia
rate of neutrophil decline
duration of neutropenia
High risk of infection in pts with ANC < _______
500 cells/mm3
Risk of infection and death are greatest in pts with ANC < ________
100 cells/mm3
Cell mediated or Humoral immunity defects?
defects in t lymphocyte and macrophage
cell mediated
Cell mediated or Humoral immunity defects?
defects in B cell function
humoral
Cell mediated or Humoral immunity defects?
results in reduced ability of the host to defend against intracellular pathogens
cell mediated
Cell mediated or Humoral immunity defects?
common bacteria pathogens found include ATYPICALS! (listeria, nocardia, legionella, mycobacteria)
cell mediated
Cell mediated or Humoral immunity defect?
common pathogen = fungi
cell mediated
Cell mediated or Humoral immunity defects?
common pathogens include S. pneumoniae, H. influenzae, N. meningitidis
humoral
most infections in cancer patients are caused by oraganisms that are colonized where?
skin
oropharynx
and GI tract
Clinical presentation in neutropenic patients?
presence of fever - probably ONLY clinical finding
wont see white cells because they are NEUTROPENIC!!
Patient factors for being low risk for infections:
- neutropenic for < ____ days
- no or few ____________
- clinically stable at ________
- no identified focus of infection/simple infection
- neutropenic for < 7 days;
- comorbidities
- onset of fever
Patient factors for being high risk for infections:
- profound/prolonged _________
- significant ________
- neutropenia = ANC < 100 and > 7 days
- comorbidities
If pt is low risk for infection and has neutropenia:
if pt has adequate outpt infrastructure (phone and transport) AND can do oral regimen…. what do you give them
cipro + amox/clav
If pt is low risk for infection and has neutropenia:
if pt has INadequate outpt infrastructure (phone and transport) OR can NOT do oral regimen…. what do you give them
IV abx MONOTHERAPY
what are the IV abx that are used in febrile neutropenic patients – LOW RISK
pip/tazo
antipseudomonal carbapenem (AKA not erta)
Cefepine
Ceftazidime
If pt is high risk for infection and has febrile neutropenic: what do you give them?
IV abx (monotherpapy)
what are the IV abx that are used in febrile neutropenic patients – HIGH RISK
same as LOW RISK!! pip/tazo antipseudomonal carbapenem (AKA not erta) Cefepine Ceftazidime
when patient is high risk febrile neutropenia:
add Vanc when?
cellulitis, pneumonia, severe sepsis/shock
known colonization with MRSA or resistant streptococci, or gram POSITIVE bacteremia
*duh no vanc needed for gram -
when patient is high risk febrile neutropenia:
if septic shock or gram - bacteremia or pneumonia add what drugs?
add aminoglycosides OR antipseudomonal FQ
consider anti fungal for septic shock
if pt has MRSA: consider early addition of what drugs?
vanc, linezolid, or daptomycin
if pt has VRE: consider early addition of what drugs?
early addition of linezolid or daptomycin
if pt has ESBL: consider early addition of what drugs?
consider early use of carbapenem
if pt has KPC producer: consider early addition of what drugs?
colistin in combo
or ceftazidime/avibactam
when to add antifungal therapy to neutropenic patients?
when pts remains febrile with undocumented infection after 4 - 7 days of broad spec abx
if pt has HSV/VZV — give what drug?
acyclovir
if pt has CMV — give what drug?
ganciclovir
what neutropenic people need antifungal prophylaxis
people getting allogenic HSCT (hematopoietic stem cell transplant)
pts undergoing intensive remission induction or salvage induction chemo for acute leukemia)
when to do antiviral prophylaxis?
acyclovir prophylaxis in HSV seroPOSITIVE pts who are geting a HSCT or leukemia infuction therapy
