Febrile Neutropenia

Question 1

What is febrile neutropenia

Answer 1

Occurrence of fever during a period of severe neutropenia in a patient with cancer and receiving chemotherapy

Question 2

T/F: Fever is likely the earliest and only sign of infection in neutropenic patients

Answer 2

True

Question 3

What primarily causes febrile neutropenia

Answer 3

GI flora

Question 4

What is a normal ANC count for a healthy individual, when are they considered severly neutropenic

Answer 4

1500, less than 500

Question 5

How does treatment of cancer aid in the cause of febrile neutropeneia

Answer 5

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

Question 6

What is the temperature that is monitored for if a patient is neutropenic

Answer 6

greater than 38.3C (101F) or a temperature of greater than 38C (100.4F) sustained over 1 hour

Question 7

If a patient presents with a fever having received chemotherapy with the last 6 weeks what are the first tasks that should be done

Answer 7

Assume a bacterial infection, collect samples, perform systematic patient assessment

Question 8

T/F: All patient diagnosed with febrile neutropenia should be given empiric antimicrobial therapy within the first 6 hours

Answer 8

False: All patients diagnosed with febrile neutropenia should be given empiric antimicrobial therapy within 1 hour

Question 9

What are the four antibiotics that can be given for empiric antimicrobial therapy regarding febrile neutropenia

Answer 9

Cefepime, meropenem, imipenem/cilastatin, piperacillin-tazobactam

Question 10

If vancomycin is required which empiric antimicrobial therapy would be used in combination with it

Answer 10

Cefepime, Meropenem, and Imipenem/Cilastatin

Question 11

If the patient has a non-anaphylaxis pencillin reaction which empiric antimicrobial therapy would be used

Answer 11

Cefepime, Meropenem, and Imipenem/Cilastatin

Question 12

If the patient has ESBL suspected which empiric antimicrobial therapy would be used

Answer 12

Meropenem or Imipenem/Cilastatin

Question 13

If the patient has a penicillin allergy that causes anaphylaxis what empiric antimicrobial therapy would be used

Answer 13

Ciprofloxacin Plus Clindamycin OR Aztreonam Plus Vancomycin

Question 14

When would using vancomycin become required in empiric antibiotic therapy

Answer 14

Hemodynamically unstable (Septic), Suspected pneumonia, suspected catheter related infection, suspected skin or soft-tissue infection, history of MRSA infection or colonization

Question 15

After giving empiric antibiotic therapy what is the next step in treating the fever neutropenia

Answer 15

Confirm the patient is neutropenic by calculating the ANC

Question 16

What is ANC, what are segs, what are bands

Answer 16

Total number of neutrophils, PMNs/mature cells, immature

Question 17

What is the equation to find ANC if neutrophils is reported as a percent

Answer 17

ANC= Total WBC X {(%PMNs/100) + (%Bands/100)}

Question 18

What is the equation to find ANC if neutrophils is reported as a total number

Answer 18

(PMNs + Bands) X 1000

Question 19

When would a patient be able to be taken off the antibiotics

Answer 19

Afebrile for at least 2 days and the ANC is above 500

Question 20

T/F: If a patient has been a febrile for 2 days and cultures are negative they can d/c antibiotics regardless of ANC

Answer 20

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

Question 21

If patient has a persistent fever or their fever becomes worse (hemodynamically unstable) what should be done

Answer 21

Broaden empiric therapy

Question 22

If a patient has a persistent fever for greater than 4 days after beginning broad spectrum antibiotics what should be done

Answer 22

Add emiric antifungal therapy to current therapy

Question 23

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

Answer 23

Ciprofloxacin or Levofloxacin PLUS Augmentin, Ciprofloxacin or Levofloxacin PLUS Clindaymycin

Question 24

If a patient is given outpatient therapy what is the goal of the therapy, what should happen if the goal is not reached

Answer 24

Defervesence within 3 days of antibiotic initiation, consider hospital readmission

Question 25

When should prophylaxis for afebrile neutropenia be considered

Answer 25

Predicted ANC less than 100 for greater than 7 days, Allogeneic hematopoietic cell transplant (HSCT), Induction chemotherapy for acute leukemia

Question 26

When would a patient receive antibacterial prophylaxis for afebrile neutropeneia, what antibiotics should be administered

Answer 26

HSCT or induction chemotherapy for acute leukemia, Ciprofloxacin or Levofloxacin

Question 27

When would a patient recieve antiviral prophylaxis for afebrile neutropeneia, what antivirals should be administered

Answer 27

HSCT or Induction chemotherapy for acute leukemia AND seropositive for HSV and/or VZV, Acyclovir or Valacyclovir along with an annual influenza vaccine

Question 28

What antifungal prophylaxis would be given if a patient is receiving HSCT, induction chemotherapy for acute leukemia

Answer 28

Fluconazole, posaconazole or Voriconazole