Febrile Neutropenia Flashcards
What is febrile neutropenia
Occurrence of fever during a period of severe neutropenia in a patient with cancer and receiving chemotherapy
T/F: Fever is likely the earliest and only sign of infection in neutropenic patients
True
What primarily causes febrile neutropenia
GI flora
What is a normal ANC count for a healthy individual, when are they considered severly neutropenic
1500, less than 500
How does treatment of cancer aid in the cause of febrile neutropeneia
Chemotherapy causes less division of rapidly dividing cells leading to loss of gastric mucus allowing GI bacteria to translocate into the blood and cause infection
What is the temperature that is monitored for if a patient is neutropenic
greater than 38.3C (101F) or a temperature of greater than 38C (100.4F) sustained over 1 hour
If a patient presents with a fever having received chemotherapy with the last 6 weeks what are the first tasks that should be done
Assume a bacterial infection, collect samples, perform systematic patient assessment
T/F: All patient diagnosed with febrile neutropenia should be given empiric antimicrobial therapy within the first 6 hours
False: All patients diagnosed with febrile neutropenia should be given empiric antimicrobial therapy within 1 hour
What are the four antibiotics that can be given for empiric antimicrobial therapy regarding febrile neutropenia
Cefepime, meropenem, imipenem/cilastatin, piperacillin-tazobactam
If vancomycin is required which empiric antimicrobial therapy would be used in combination with it
Cefepime, Meropenem, and Imipenem/Cilastatin
If the patient has a non-anaphylaxis pencillin reaction which empiric antimicrobial therapy would be used
Cefepime, Meropenem, and Imipenem/Cilastatin
If the patient has ESBL suspected which empiric antimicrobial therapy would be used
Meropenem or Imipenem/Cilastatin
If the patient has a penicillin allergy that causes anaphylaxis what empiric antimicrobial therapy would be used
Ciprofloxacin Plus Clindamycin OR Aztreonam Plus Vancomycin
When would using vancomycin become required in empiric antibiotic therapy
Hemodynamically unstable (Septic), Suspected pneumonia, suspected catheter related infection, suspected skin or soft-tissue infection, history of MRSA infection or colonization
After giving empiric antibiotic therapy what is the next step in treating the fever neutropenia
Confirm the patient is neutropenic by calculating the ANC
What is ANC, what are segs, what are bands
Total number of neutrophils, PMNs/mature cells, immature
What is the equation to find ANC if neutrophils is reported as a percent
ANC= Total WBC X {(%PMNs/100) + (%Bands/100)}
What is the equation to find ANC if neutrophils is reported as a total number
(PMNs + Bands) X 1000
When would a patient be able to be taken off the antibiotics
Afebrile for at least 2 days and the ANC is above 500
T/F: If a patient has been a febrile for 2 days and cultures are negative they can d/c antibiotics regardless of ANC
False: In order to to d/c antibiotics the patient must be afebrile for 2 days AND have their ANC be returned to at least 500
If patient has a persistent fever or their fever becomes worse (hemodynamically unstable) what should be done
Broaden empiric therapy
If a patient has a persistent fever for greater than 4 days after beginning broad spectrum antibiotics what should be done
Add emiric antifungal therapy to current therapy
If a patient one or more empiric antibiotic dose as inpatient and IS a canidate for outpatient managment what will they be given if there is no penicillin allergy, with a penicillin allergy
Ciprofloxacin or Levofloxacin PLUS Augmentin, Ciprofloxacin or Levofloxacin PLUS Clindaymycin
If a patient is given outpatient therapy what is the goal of the therapy, what should happen if the goal is not reached
Defervesence within 3 days of antibiotic initiation, consider hospital readmission
