Infection in neutropenic patients Flashcards
1
Q
What increases the risk of neutropenic infection?
A
•Cause of neutropenia –marrow failure is associated with a higher risk than immune destruction •Degree of neutropenia < 0.5 x 109/l - significant risk < 0.2 x 109/l - high risk •Duration of neutropenia > 7 days - high risk
2
Q
what are additional risks which increase risk of neutropenic infection?
A
•Disrupted skin / mucosal surfaces –Hickman line, venflons/ pick line –Mucositis affecting GI tract –GVHD •Altered flora/ antibiotic resistance –Prophylactic antibiotics •Lymphopenia –Disease process e.g. Lymphoma –Treatment –Stem cell transplantation, GVHD •Monocytopenia –Hairy cell leukaemia- immunity to fungal infections was suppressed –Chemotherapy
3
Q
what organisms are involved in infective neutropenia
A
- Gram +ve : MSSA/ MRSA
- Gram -ve: e.coli, klebsiella, pseudomonas aeruginosa
- Fungal: candida, aspergillus
4
Q
what is the presentation for neutropenic sepsis
A
•Fever with no localising signs Single reading of >38.50C or 380C on two readings one hour apart •Rigors •Chest infection/ pneumonia •Skin sepsis - cellulitis •Urinary tract infection •Septic shock
5
Q
How do you manage neutropenic sepsis
A
SEPSIS 6 BUT
- IV broad antibiotics used are tazocin and gentamicin
- If a gram negative is identified then add vancomycin/ teicoplanin
- If no response in 72 hours add an anti fungal
- CT chest/ abdomen/pelvis to look for source.
6
Q
who is at risk of getting a lymphopenic infection
A
- stem cell recipients
- recipients of Total body irradiation
- Graft vs host disease
- Nucleoside analogues
- Lymphoid malignancy
7
Q
what can lead to lymphipenic infection
A
• Atypical pneumonia – Pneumocystis Jirovecii (PJP) – CMV – RSV • Viral – Shingles (Varicella Zoster) – Mouth ulcers (Herpes simplex) – Adenovirus – EBV (PTLD: post transplant lymphoproliferative disease) • Fungal –candida, aspergillus, mucormycosis • Atypical mycobacteria –Skin lesions, pulmonary and hepatic involvement
