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PHRM 865 > Infections in Immunocompromised Patients > Flashcards

Infections in Immunocompromised Patients Flashcards

1
Q

What are the risk factors for development of infections in immunocompromised patients?

A
  • Neutropenia
  • Immune system defects
  • Destruction of skin barrier
  • Environmental contamination/ alteration of microbial flora
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2
Q

What are the common bacteria found in immunocompromised patients?

A
  • S. aureus
  • S. epidermis
  • Streptococci
  • Enterococcus
  • Enterobacterales
  • P. aeruginosa
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3
Q

What are the common fungi found in immunocompromised patients?

A
  • Candida
  • Aspergillus
  • Zygomycetes (mucor, rhizopus)
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4
Q

What are the common viruses found in immunocompromised patients?

A
  • HSV
  • VZV
  • CMV
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5
Q

Define neutropenia.

A

ANC <1,000 cells/mm3

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6
Q

What does defects in T-lymphocyte and macrophage function lead to?

A

Reduced ability to defend against intracellular pathogens

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7
Q

What does defects in B-lymphocyte function lead to?

A

Reduced ability to defend against extracellular pathogens

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8
Q

What is the most important clinical presentation of infections in neutropenic cancer patients?

A

Fever - may be only clinical finding:
- single oral temp of ≥38.3C (≥101F), or
- oral temp ≥38C (≥100.4F) persisting for 1 hour or longer

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9
Q

What are the problems associated with documenting the etiology of the infection?

A
  • Non-infectious causes could cause fever
  • Other s/sxs of infection usually absent due to neutropenia
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10
Q

What are the non-infectious causes of fever?

A

Blood products, chemo, drug fever, underlying malignancy

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11
Q

What is considered low risk neutropenia?

A
  • Neutropenia ≤7 days
  • Clinically stable
  • Inpt or outpt, IV and/or PO
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12
Q

What is considered high risk neutropenia?

A
  • ANC ≤100 cells/mm3 AND neutropenia >7 days
  • Clinically unstable
  • Inpt, IV therapy
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13
Q

What are the empiric antimicrobial regimen options for management of febrile neutropenia?

A

B-lactam monotherapy:
- Cefepime 2gm q8h
- Zosyn 4.5g q6h
- Ceftazidime 2gm q8h
- Imipenem 500mg q6h
- Meropenem 1gm q8h

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14
Q

Should vanco be added in management of febrile neutropenia?

A

NOT recommended as part of empiric regimen

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15
Q

When to add vanco?

A
  • Hemodynamic instability/sepsis
  • Pneumonia
  • Blood cultures growing G+ bacteria
  • Line/port infection
  • SSTI
  • Severe mucositis
  • Colonization w/ resistant G+ bacteria
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16
Q

What is the empiric regimen for febrile neutropenic patient with type 1 hypersensitivity penicillin allergy (hives, anaphylaxis)?

A

Cipro + aztreonam + vanco

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17
Q

What is the oral antimicrobiotic regimens for low risk neutropenic patients?

A
  • Cipro + augmentin or clinda
  • Levo
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18
Q

Pathogen directed therapy for MRSA.

A

Vanco

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19
Q

Pathogen directed therapy for VRE.

A

Dapto or linezolid

20
Q

Pathogen directed therapy for ESBL.

A

Carbapenem

21
Q

Pathogen directed therapy for KPC.

A
  • Meropenem/vaborbactam
  • Imipenem/cilastatin/relebactam
  • Ceftazidime/avibactam
22
Q

Pathogen directed therapy for NDM/IMP/VIM.

A

Cefiderocol

23
Q

When to initiate antifungal therapy.

A
  • High incidence of fungal infection at autopsy
  • Pts w/ persistent fever or develop new fever w/ undocumented infection of 4-7 days of broad-spectrum antibiotics
  • <50% positive blood cultures in neutropenic pts w/ invasive fungal infection (IFI)
24
Q

Treatment options for antifungal therapy.

A
  • Amphotericin B deoxycholate or liposomal amphotericin B
  • Azoles
  • Echinocandins: the -fungins
25
Duration of antifungal therapy.
2 weeks in absence of s/sxs of IFI - often continued for duration of neutropenia
26
When to initiate antiviral therapy.
- Vesicular/ulcerative skin or mucosal lesions - Presumed or confirmed viral infection
27
Treatment options for antiviral therapy.
- For HSV/ZVZ: acyclovir, valacyclovir - For CMV: ganciclovir, valganciclovir
28
Indications for catheter removal.
- Subq tunnel infection - Failure to clear blood cultures after 72hrs on appropriate therapy - Persistent fever - Septic emboli - These pathogens: fungi, mycobacteria, P. aeruginosa, bacillus, C. jeikeium
29
Treatment duration with SSTI.
7-14 days
30
Treatment duration with CLABSI.
2-6 weeks
31
Treatment duration with pneumonia.
10-21 days
32
Treatment duration with sinusitis.
10 days
33
Treatment duration with UTI.
7-14 days
34
Treatment duration with aspergillus.
12 weeks
35
Treatment duration with HSV/VZV.
7-10 days
36
Treatment duration with influenza.
5 days
37
When could CSFs (filgrastim, sargramostim) be used?
May be useful in patients w/: - ANC ≤500 - Uncontrolled primary disease - PNA, IFI - Hypotension, sepsis, multiorgan dysfunction
38
What is the prophylaxis treatment options for neutropenic patients?
Cipro or levo
39
Use of FQ prophylaxis in empiric regimen.
Do NOT use
40
Which patient populations require FQ prophylaxis?
- Moderate to high risk pts w/ expected ANC ≤100 for >7 days - Heme malignancies (AML, MM, lymphoma, CLL) - Allogeneic and autologous HSCT - GVHD w/ high dose steroids - Use of alemtuzumab
41
Which patient populations require antifungal prophylaxis?
- Allogeneic HSCT - Intensive induction chemo for acute leukemia - AML, MDS, GVHD on high dose steroids
42
Antifungal prophylaxis options.
- Azoles - Echinocandins
43
Specific antifungal prophylaxis regimen for AML, MDS, GVHD on high dose steroids patients.
Posaconazole or isavuconazole
44
Which patient population requires antiviral prophylaxis?
HSV seropositive pts undergoing allogeneic HSCT or leukemia induction therapy
45
Specific antiviral prophylaxis regimen for HSV seropositive patients undergoing allogeneic HSCT or leukemia induction therapy.
Acyclovir
46
Vaccine recommendations for antiviral prophylaxis.
- Annual influenza vaccine recommended in ALL pts - Varicella vaccine
47
Which patient populations would be placed on Bactrim prophylaxis?
- Allogeneic HSCT and GVHD on high dose steroids - Reduce PJP pneumonia risk

PHRM 865 (13 decks)

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