immunocompromised patient infections

Question 1

Risk Factors for infection in immunocompromised pts

Answer 1

-neutropenia
-immune system defects
-destruction of protective factors
-enviromental contamination/ alteration of microbial flora

Question 2

neutropenia

Answer 2

-Reduction in the number of circulating neutrophils
-ANC < 1000
-highest risk for infection with longer duration

Question 3

ANC=

Answer 3

WBC x (%polys + %bands)

Question 4

Defects in T-lymphocytes and macrophage function

Answer 4

Reduced ability of the host to defend against intercellular pathogens

Question 5

Defects in B-lymphocyte function

Answer 5

Reduced ability of host to defend against extracellular pathogens
-encapsulated bacteria

Question 6

Common pathogens with destruction of the skin

Answer 6

-s.auerus
-s.epidermis
-candida spp

Question 7

environmental contamination

Answer 7

-Translocation of bacteria
-contaminated water + food

Question 8

oropharyngeal flora rapidly change to

Answer 8

gram - bacilli in hospitalized patients

Question 9

greatest risk of infection in immunocompromised patients

Answer 9

profounf neutropenia
-ANC < 500

Question 10

gram + bacteria and morbidity

Answer 10

decreased morbidity and mortality

Question 11

most common fungal infection

Answer 11

candida albicans

Question 12

the most important finding in neutropenic patients
(maybe the only clinical finding)

Answer 12

fever

Question 13

febrile neutropenia
empirical treatment should include

Answer 13

antipseudomonal coverage

Question 14

febrile neutropenia
empiric treatment options

Answer 14

beta lactam monotherapy
-cefepime 2g q8h
-piperacillin/tazobactam 4.5g q6h

Question 15

what is not recommended as standad part of initial empiric regimen of febrile neutropenia

Answer 15

VANC

Question 16

febrile neutropenia
management w/ pcn allergy

Answer 16

ciprofloxacin + aztreonam + vancomycin

Question 17

low-risk febrile neutropenia
treatment

Answer 17

oral ciprofloxacin + augmentin

Question 18

febrile neutropenia
Antifungal therapy indication

Answer 18

-persistent fever or new fever w/ undocumented infection after 4-7 days of broad spectrum abx

Question 19

febrile neutropenia
Antifungal therapy
treatment options

Answer 19

-amphotericin B
-azoles
-echinocandins

Question 20

febrile neutropenia
Antiviral therapy
treatment options

Answer 20

hsv/vzv
-acyclovir, valacyclovir
cmv
-ganciclovir, valganciclovir

Question 21

most important determinant in patient outcomes for febrile neutropenia

Answer 21

resolution of neutropenia

Question 22

febrile neutropenia
prophylaxis

Answer 22

fluorquinolone
-ciprofloxacin
-levofloxacin
-do not used in treatment