Lecture 12 - Neutropenic Fever

Question 1

Neutropenia definition

Answer 1

Severe = ANC < 500
Profound = ANC < 1,000
Neutropenia = ANC < 1,500

Question 2

who experience Neutropenia

Answer 2

Onc/Hematology***
HIV
Immunosuppressed
Congenital neurtopenia
Aplastic anemia

Question 3

Neutropenic Fever defintion

Answer 3

> 101/38.3 or > 100.4/38 for 1 hr

ANC < 1500

Question 4

ANC calculation

Answer 4

WBC X (% neutrophils + % bands)

Question 5

Risk factors for Neutropenic Fever

Answer 5

Surgical sites
IV lines
Mucositis = breakdown of mucosal barrier
Radiation

Question 6

Etiology of Infections in NF?

Answer 6

Gram + = 60-70%
Gram - = 30-40%

Question 7

Options for initial therapy NF (Monotherapies)

Answer 7

Carbapenem
Ceftazidime or cefepime
Pip/tazo

Question 8

Options for initial therapy NF (combos)

Answer 8

Antipseudo pen + AG
Antipseudo ceph + AG

Antipseudo ceph + Antipseudo pen
Antipseudo ceph + Aztreonam

AG + Quinolone (good for ppl with allergies)

Question 9

Antipseudomonal Penicillins

Answer 9

Pip/tazo

Question 10

Antipseudomonal Cephalosporins

Answer 10

Ceftaz
Cefepime

Question 11

Oral therapy for NF patients

Answer 11

Cipro 750 q12h + Augmentin 875 q12h

Only Low Risk patients (no comorbidites, other issues, dont need hospital)

50% fail and need IV (persistent fever/signs of infection)

Question 12

When is MRSA saved for

Answer 12

pts with documented MRSA culture
Pts with high suspicion and catheter-related signs and symptoms

Question 13

most pt response?

Answer 13

continue to have fevers
if no sign sepsis, stay course of therapy
If fever persists >4/5 days, consider antifungal coverage

Question 14

If ppl have MRSA then use…

Answer 14

Vanco
Linezolid
Dapto

Question 15

If ppl have VRE then use

Answer 15

Linezolid
Tidezolid
Dapto

Question 16

If ppl have ESBL then use….

Answer 16

Carbapenem

Question 17

If ppl have KPC then use…

Answer 17

Polymyxin-colistin
Tigecycline

Question 18

If ppl have Severe Penicillin Allergy then use

Answer 18

Treat w/ combo to avoid beta-lactams

Cipro + clinda
Aztreonam + vanco

Question 19

What to avoid for Neutropenic ppl

Answer 19

Avoid Fresh fruits, veggies, plants, flowers, smoking

Avoid invasive procedures

Good handwashing

Question 20

Filgrastim info

Answer 20

dont usually add it but do continue if they’re already on it

Sargramostin = more SE

Question 21

Recovering from Febrile Neutropenia, if patient had documented infection then…

Answer 21

make sure total antibiotic duration is appropriate for infection type

Question 22

Recovering from Febrile Neutropenia, if pt didn’t have documented infection then….

Answer 22

when ANC > 500-1000 and stable you can D/c ABX and Antifungal

Question 23

Early Therapy for oral candidiasis

Answer 23

Nystatin 50ml PO QID

Clotrimazole 1 Troche 5 X Daily

Azole therapy
Fluc 100-200 Daily
Posaco 100 BID 1 day, then 100 QD

Question 24

When do we start thinking of systemic antifungals

Answer 24

> 5-7 days of neutropenia associated w/ persistent fever

Question 25

2 fungal diagnosti tests?

Answer 25

Aspergillus galactomannan antigen test
Beta-1-3-D-glucan assay

can use to try and detect infection

Question 26

systemic antifungal coverage chart

Answer 26

If > 5 days fever on broad spectrum antibiotics, add antifungal

Liposomal Amp B
Caspo/Mica
Voriconazole

Question 27

Drug related issues to consider Liposomal Ampho B

Answer 27

Broad spectrum
ADEs: Nephrotoxicity, hypokalemia/magnesemia
Fever, chills, infusion reactions (Premedicate)