Febrile Neutropenia

Question 1

Febrile Neutropenia Diagnostic criteria

Answer 1

Fever:

*Oral temp ≥ 38.3 C (101 F) x 1 reading
OR
Oral temp ≥ 38 C (100.4 F) sustained for > 1 H

Neutropenia:

*ANC < 500 cells/mm3
OR
ANC < 1,000 and expected to decrease to < 500 over the next 48 H

Question 2

when should EMPIRIC ABX be started

Answer 2

IMMEDIATELY if a FEVER occurs in a neutropenic patient

Question 3

what type of bacteria has the HIGHEST RISK of causing SEPSIS and death in neutropenic patients

Answer 3

GRAM NEGATIVE bacteria

Question 4

what should the INITIAL empiric abx regimen provide adequate activity against other than gram negative bacteria

Answer 4

PSEUDOMONAS aeruginosa

Question 5

Low risk patient:

Q: criteria
Q: empiric abx treatment

Answer 5

1. expected ANC ≤ 100 for < 7 days, No comorbidities
2. Oral anti-pseudomonal abx
   *CIPROFLOXACIN or LEVOFLOXACIN

                        PLUS (+)  Augmentin (gram positive bacteria) or Clindamycin (if allergic to PCN)

Question 6

High risk patient:

Q: criteria
Q: empiric abx

Answer 6

1. Expected ANC ≤ 100 for ≥ 7 days
   Presence of comorbidities
   Evidence of renal/hepatic impairment (CrCl < 30 or LFTs > 5x UNL)
2. IV anti-pseudomonal beta-lactams
   *CEFEPIME or CEFTAZADIME or IMIPENEM/CILASTIN or MEROPENEM or ZOSYN