Infxns in Immunocompromised Pts Flashcards
what pt is at the HIGHEST risk for infxn
Prolonged neutropenia + Broad Spectrum Antibiotic +/- steroids
What ANC level puts pts at greatest risk
<500
TMP-SMX PTx
- allogenic HSCT + GVHD on high high-dose steroid
Antiviral PTx
- HSV pts undergoing allogenic HSLT or Leukemia Tx
- Acyclovir
Antifungal PTx
- Allogenic HSCT, chemo for acute Leukemia
- Azoles or Echinocandins
Bacterial PTx
- Cipro or Levo
Risk Factors
- Neutropenia (ANC<1000)
- Immune system defect
- destruction of protective barrier
- environmental contaminator/alt of microbial flora
Common Viral pathogens in immunocomped pts
- HSV
- VZV
- CMV
Common Fungal pathogens in immunocomped pts
- Candida
- Asperigillus
- Zygomyctes
Common Bacterial pathogens in immunocomped pts
- Staph
- Strep
- Enterococcus
- Pseudomonas
When to use Vanc as initial empiric Tx
- hemodynamically unstable/sepsis
- PNA
- G(+) bac on BC
- Line/port infxn
- SSTI
- severe mucositis
- colonization w/ resistant G(+) bac
HSV/VZV duration
7-10d
Sinusitis Duration
10d
PNA Duration
10-21d
Flu Duration
5d
CLABSI Duration
(central line associated blood stream infxn)
2-6 weeks
UTI Duration
7-14d
SSTI Duration
7-14d
Most important thing for pt outcomes
Resolution of Neutropenia
Infxns in Neutropenic Febrile - Antiviral Tx
- HSV/VZV: Acyclovir, Valacyclovir
- CMV: Ganciclovir, Valganciclovir
Infxns in Neutropenic Febrile Cancer Pts - Antifungal Tx
- initiate in pts w/ persistant fever or new fever w/ undocumented infxn after 4-7day of broad-antibiotics
- Azoles
- Echinocandins (“fungins”)
- Amphotericin B
Infxns in Neutropenic Febrile Cancer Pts - Empiric Tx
- B-Lactam MonoTx: Cefepime, Zosyn, Ceftazidime(no G+ activity), Imipenem, or Meropenem
- PCN Ax: Cipro+Aztreonam+Vanc
- If low risk: PO Cipro+Augmentin, Levo, or Cipro+Clinda
