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Clin Med II > Neutropenic Fever > Flashcards

Neutropenic Fever Flashcards

1
Q

What is the definition of neutropenic fever

A

Fever in the setting of cancer and active chemotherapy

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2
Q

What is the most common etiology of neutropenic fever (broad not specific), and why?

A

Usually caused by colonizing bacteria or yeast of the GI tract because the chemo disrupts mucous membranes of mouth and GI tract allowing for organisms to enter

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3
Q

What is the earliest symptom of infection for neutropenic fever

A

fever

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4
Q

What temps are actually considered a fever

A

Single temp measured at _>_38.3 C OR 101F

or

_>_38.0 C (100.4) sustained over one hour period

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5
Q

What is the cut off of ANC for neutropenic fever

A

ANC of <500 cells/microL or an ANC that is expected to decrease to <500 cell/microL within 48 hours

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6
Q

What is functional neutropenia

A

When a pt has >500/microL but because of a hematological malignancy that impacts fxn of cells they are at higher risk of infection

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7
Q

How do you calculate the ANC

A

Total WBC x (%PMNs + %bands)

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8
Q

What is considered a low risk neutropenic fever pt

A

-Expected to be neutropenic for <7 days

No comorbities (like renal or liver dysfunction)

Solid tumor chemo regimen

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9
Q

What is considered high risk for pts with neutropenic fever

A

Neutropenia expected >7 days

Ongoing comorbities

Hematologic cancers (especially leukemias)

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10
Q

WHat is the MASCC score

A

Multinational association of supportive care in cancer

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11
Q

What is the max MASCC score

A

26

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12
Q

What mask score is considered high risk

A

<21 is high risk (the lower the number the higher the risk)

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13
Q

Ask if we need to know the scores by heart or not- screen shot on back of this card

A
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14
Q

What are the most common causative organisms of neutropenic fever

A

GNR- particularly pseudo

GPC- particularly S epi

MRSA sometimes

Candida/aspergillus

Herpes/Herpes zoster/CMV

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15
Q

What are the three different presentations of neutropenic fever (in order of easiest to hardest to treat)

A
  1. Microbiologically documented infxn- culture is positive
  2. Clinically documented infection that is not cultured (ex: cellulitis)
  3. Unexplained fever with no clinical focus or positive culture
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16
Q

What are the important things to look for when taking a pt hx with neutropenic fever

A

Probing for risk factors/ signs and sx of source of infxn

Finding out what organism a pt had in a previous infxn

Ask about non-infectious causes like recent transfusions

Ask about comorbidities (risk stratification)

17
Q

What is the most common site of infxn in neutropenic fever

A

Lungs

18
Q

What sites should be examined if a pt has neutropenic fever

A

Lungs

Indwelling catheters/ports/IVs

Skin and mucous membranes

Perianal exam (but DO NOT PERFORM DRT)

19
Q

What labs should be performed in a pt with neutropenic fever

A

BC

CBC

CMP

UA with Culture

Sputum Culture (if productive cough)

Stool Culture with C. diff testing if diarrhea is present

CSF testing if there is any HA or nuchal rigidity

20
Q

What are the imaging modalities used when a pt has neutropenic fever

A

CXR in low risk (since lung is most common spot)

CT scan of chest in high risk pts

CT of whatever site is suspicious for infxn

21
Q

What is always an emergency in neutropenic pts

A

a fever

22
Q

What is the first step for tx of neutropenic fever

A

Immediately starting Abx (within one hour of fever onset- but after collecting BC if at all possible)

23
Q

How often is bacteremia present in neutropenic fever pts

A

10-25% of the time

24
Q

Is neutropenic fever more common in blood cancers or solid tumors

A

Blood cancers

25
Q

What are the empiric txs for high risk pts with neutropenic fever

A
  • Ceftazidime 2G IV q8hr
  • Cefepime 2GIV q12h
  • Pip/Tazo 4.5G IV q6h

-Imipenem 500mg IV q6h

-Meropenem 1G IV q8h

bolded= for more resistant organism susp.

26
Q

What are the empiric tx for low risk pts with neutropenic fever

A

Cipro 500mg po bid

OR

Levo 750mg po bid

AND

Amox/Clav 500/125 mg po TID

27
Q

When would you cover for GPC in a high risk pt with neutropenic fever

A

If the pt is hemodynamically unstable or has evidence of severe sepsis

Pneumonia documented

Pos BC for GPC

Catheter related infxn (chills post infusion)

Skin or soft tissue infxn

Colonization with MRSA

Severe mucositis

28
Q

How long do you tx pts with neturopenic fever with abx

A

until the pts ANC is >500 (and some physicians continue abx for 24-48 hours after)

29
Q

When are fluoroquinolones used to prophylax pts

A

if a pt is expected to have a prolonged or profound neutropenia (like bone marrow transplant pts)

30
Q

Do you prophylax for GP organisms

A

no

31
Q

When do you prophylax for candidal infxn

A

When a pt is undergoing HSCT or induction for acute leukemia

32
Q

When do you prophylax for aspergillus in pts

A

age 13 and over undergoing intensive chemo for AML/MDS

33
Q

What is used to prophylax for aspergillus

A

posaconazole

34
Q

Do you prophylax pts undergoing tx for solid tumors

A

no

35
Q

When are hematopoietic growth factors given to pts

A

When a pt has anticipated risk of fever and neutropenia is 20% or greater

-Not considered normally if a pt already has febrile neutropenia

Clin Med II (8 decks)

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