Neutropenia Flashcards
Per IDSA 2011 guidelines neutropenia is ANC < __ cells/mm3
500
With cancer, the type of __ dictates expected neutropenia
chemotherapy
What physiological response do neutropenic pts have to infection?
fever
Fever is a single oral temp >= __C
38.3
101F
Fever is a temp of >= __C for >=1 hour
38
100.4
Common gram positive in neutropenia?
Staph aureus
2 common gram negatives in neutropenia?
Pseudomonas
enterobacteriaceae
Failure to provide anti___ therapy within 48 hours of onset of fever in neutropenic cancer pts has led to mortality rates as high as __ %
pseudomonal, 70
empiric therapy is 70-90% effective at reducing early morbidity and mortality
Common sources of infection?
IV lines (Port, PICC) mucositis
2 main alterations of patient’s microbiota that are risk factors?
antibiotics
acid suppression
Duration > ___ days is high risk for febrile neutropenia
7-10
What drug is high risk for febrile neutropenia?
alemtuzumab
___ HCT is high risk for febrile neutropenia
a. autologous
b. allogeneic
b. allogeneic
Fluoroquinolones have a FDA alert for hypo/hyperglycemia
a. true
b. false
a. true
2 main FDA alerts for fluoroquinolones?
hypo/hyperglycemia
aortic dissection or ruptures
What antibiotic class is given for intermediate and high risk neutropenic fever prophylaxis?
fluoroquinolones
Fluoroquinolones can cause C.diff
a. true
b. false
a. true
IV antibiotics is necessary for inpatient treatment
a. true
b. false
a. true
monotherapy preferred:
- cefepime
- ceftazidime
- carbapenem
- pip-taz
What is goal trough for vanc in empiric neutropenic fever Tx?
10-15
When can vanc be used as initial empiric therapy?
sepsis pneumonia gram positive organism isolated suspected CLABSI MRSA severe mucositis
What is drug of choice for neutropenic fever Tx?
cefepime
When should antifungal coverage be added?
if persistent fever after 4-7 days of broad spectrum therapy
What drug is added for antifungal therapy?
echinocandin
Invasive fungal infections are more common with profound neutropenia for > __ to __ days
5, 10
profound neutropenia is ANC < 100
Do not use itraconazole for neutropenic fever
a. true
b. false
a. true
does not have appropriate coverage; use tori or post/isavu
Gram positive empiric coverage can be d/c after __ days if no evidence of gram positive infection
2
G-CSF is not generally recommended for febrile neutropenia
a. true
b. false
a. true
____ organisms are the most common cause of neutropenic fever
a. gram positive
b. gram negative
a. gram positive
___ organisms cause mortality the quickest
a. gram positive
b. gram negative
b. gram negative