Lecture 36: Molecular medicine; A case of febrile neurtopenia Flashcards
Febrile neutropenia
- Can be caused by chemo?
- Common in severely neutropenic patients
- High rates of bactaraemia
- Infections from endogenous gut and skin (through catheter?) flora
- Very high mortality in patients with gram- bacteria
- Improved outcome with empiric antibiotic use
Rigors
Uncontrolled prolonged shivering, often in severe infection
Risk on infection if neutrophils <0.1
NOTE not all cancer treatments will cause it this bad, common in haematologic cancer treatment
Duration of 1 week- 33% severe infection
Duration of 6 weeks- 100% severe infection
Common infectiou agents in febrile neutropenia
Gram + staphylococci and streptococci.
Aerobic gram -ve bacilli (E. Coli, Pseudomonas aeruginosa)
Empiric antibiotic regiment, before known organism
Tazocin (piperacillin and tazobactam): Active against almost all aerobic bacteria
+
Gentamicin (aminoglycoside): active against almost all aerobic gram -ve bacilli
Ideas to reduce conseqeunces of febrile neutropenia?
Antibiotic prophylaxis- controversial
Haematopoietic growth factors such as G-CSF
Nurse patients in isolation
Reduced intensity of chemo