infection in patient with haematological malignancy Flashcards
which immune cells do you need
neutrophils: bacterial, fungal
monocytes: fungal
eosinophils: parasitic
T cells: viral, fungal, PJP
B cells: bacterial
reducing sepsis risk in those w haematological malignancy
prophylaxis growth factors SCT protective replacement Ig vaccination
reducing sepsis risk: prophylaxis
antibiotics: ciprofloxacin
antifungal: fluconazole
antiviral: aciclovir
PJP: co-trimoxazole
reducing sepsis risk: growth factors
e.g. G-CSF
speed up neutrophil recovery, reduce duration of neutropenia
reducing sepsis risk: protective environment
laminar flow rooms
positive air pressure to blow anything out - bugs cant get in
reducing sepsis risk SCT
speed up recovery of bone marrow after chemo
assessing neutropenic risk
cause of neutropenia: bone marrow failure worse higher risk than immune destruction
degree of neutropenia: <0.5 signif risk, <0.2 high risk
duration of neutropenia: >7d high risk
additional risk factors for infection
distrupted skin/mucosal surface
altered flora/antibiotic resistance: antib prophylaxis
monocytopenia: hairy cell leukaemia, chemo
lymphopenia: lymphoma, fludarabine
febrile neutropenic gram positive bacterial causes
staph: MSSA, MRSA, coagulase - strep viridians enterococcus faecalis, faecium baccilus corneybacterium
febrile neutropenic gram negative bacterial cause
e.coli
klebsiella
enterobacter
pseudomonas aurugisona
possible sites of infection
skin sores mouth ulcers GI dental sepsis exit site central venous catheter resp tract perianal - avoid PRs
presentation of neutropenic sepsis
fever: no localisation, >38.5 singe reading or 2 reading >38 rigors chest infection, pneumonia skin - cellulitis UTI septic shock
sepsis 6
blood culture blood lactate measure urine output oxygen fluid resusc IV antib
investigations neutropenic fever
blood cultures Hx and exam: point to source coag screen FBC, U&Es, LFTs CXR sputum throat swab + other clinical areas infection
Mx neutropenic sepsis
resus - ABC
broad sepctrum antib
chest/abdo/pelvic CT
modify Rx based on culture results
