Febrile Neutropenia

Question 1

What % of onc pt experience F+N?

Answer 1

80% liquid, 20% solid

Question 2

MC sites of infection (if identified)

Answer 2

lung, intestine, skin

Question 3

Define F+N

Answer 3

T is 38.0/100.5+

<500 neutrophils/mm3

Question 4

Order of action when F+N

Answer 4

Blood cultures x 2
Abx w/in 1 hour
*line draw if line suspected cause of infection
*CXR with resp signs

Question 5

Pt is elderly, NKDA. What 1stline broad spectrum abx to give?

Answer 5

Ceftazadine

Question 6

Pt has CKD/kidney dysfunction. What 1stline BS abx to give?

Answer 6

Ceftazadine

Question 7

Pt has mucositis. What 1stline BS abx to give?

Answer 7

Cefepime, because better for G+ and mucosistis usually cause by G+

Question 8

Chart says pt resistant to cefazolin or cefoxitine. What do you give?

Answer 8

Cefepime, because less chance of inducing ESBL

Question 9

Pt allergic to cephalosporins. What are your first and second line choices

Answer 9

2. Zosyn

3. Imipenem/Carbopenem

Question 10

Pt develops a fever on BS abx. What to add?

Answer 10

Microfungin

Question 11

What are some cases when vanco is apporp?

Answer 11

HD unstable, severe sepsis, skin/soft tissue infection

Question 12

Pt is clinically stable but still febrile. What do you do?

Answer 12

Clinical assessments to ensure not missing anything like mucosititis/typhilitis, etc

Question 13

When would you get a TTE?

Answer 13

1. Staph aureus

2. sustained high grade bacteremia

Question 14

When would you remove line?

Answer 14

1. Some specific bugs (S. aureus, Psuedomonas, C. jeikuim, etc)
2. Septic thrombosis
3. Endocarditis
4. Septic + HD instability
5. CLABSI
6. Bacteremia 72h w/ therapy
7. Tunnel/pocket site infxn

Question 15

What to do if CLABSI but you dont want to remove line?

Answer 15

Antimicrobials + EtOH lock

*not all lines compatible with EtOH lock

Question 16

How long to treat in general

Answer 16

14d from 1st negative blood culture

Question 17

How long to treat - S. aureus, deep, disemminated

Answer 17

4-6 weeks

Question 18

Name other yeasts that are not candida

Answer 18

cryptococcus, saccahromyces

Question 19

Pt has candida. Do you remove line?

Answer 19

Yes, due to biofilm risk

Question 20

How long to treat - end organ infection like typhylitis

Answer 20

14 days from COUNT RECOVERY (not negative culture)

Question 21

How long to treat - endocarditis

Answer 21

6 weeks

Question 22

Why wouldn’t you use daptomycin for PNA

Answer 22

inactivated by surfactant

Question 23

What lab to do in BMT candidate with adenovirus

Answer 23

viral load - need to determine viremia

Question 24

An important complication of candidiasis to rule out early

Answer 24

candida exopthalmous