febrile neutropenia

Question 1

Febrile neutropenia definition:

Answer 1

temperature >101 and abs neutrophil count <500

Question 2

most cases of Febrile neutropenia are a result of:

Answer 2

staph epi, staph aureus, streptococcus can see pseudomonas infections in 25% of cases

Question 3

1st line monotherapy for Febrile neutropenia is

Answer 3

antipseudomonal beta lactam (zosyn or cefepine) for inpt settings no mortality benefit with second agent with vancomycin targeting gram positive agents

Question 4

when to add a second line antibiotic for Febrile neutropenia ?

Answer 4

add vancomycin to target gram positive pathogens indications for vancomycin are: Hemodynamic instability severe sepsis pneumonia positive blood cultures for gram positive organism (prior to speciation) suspected catheter related infection (chills during infusion, cellulitis around entry site) skin or soft tissue infection

Question 5

when do you double cover for pseudomonas infections in Febrile neutropenia

Answer 5

CONTROVERSIAL but only use if in septic shock, burn pts with severe infection or at high risk for multidrug resistant infection.

Question 6

when to add empiric antifungal coverage?

Answer 6

when pt has been febrile for >4-7 days and undergoing extensive induction chemotherapy for acute leukemia people who recently have undergone stem cell transplant

Question 8

Treatment algorithm for febrile neutropenia

Answer 8