Neutropenic Fever Flashcards
first WBC to arrive to site of injury
neutrophil
WBC that can attack up to 1-2 dozen BACTERIA
neutrophil
Fever = (2)
- single oral temp > 38.3C / 101F
2. temp of >38 / 100.4F on 2 occasions separated by 1 hr
neutropenia =
ANC < 1500 cells / microL
severe neutropenia
ANC < 500 cells or expected w/in 48 hrs
profound neutropenia
ANC < 100 cells / mm3
ANC =
total WBC X % neutrophils
the more lobes (2-4)/bands
the more immature the neutophil–the more acute the infection–Left-shift–bandemia
neutropenic fever =
fever in someone w/ neutropenia
ANC
absolute neutrophil count
Neutropenia causes (2)
- ^ utilization (sepsis)
2. v production (bone marrow) –leukemia, drugs (CHEMO), HIV
Neutropenic fever management
a medical emergency–> immediate ER eval
Before antibiotics most neutropenic fever pt’s _____
died
Neutropenic Fever initial eval
- ENSURE HEMODYNAMIC STABILITY
- History
- review of histories
- Focused Exam
- lines or in-dwelling hardware
Splenectomy think (3) w/ neutropenic fever pt’s – Tx accordingly
- Strep pneumo
- N. meningitidis
- H. influenzae
for Neutropenic Fever–stay away from ____ _____!
rectal exam!
skin exam w/ neutropenic fever may find (2)
- petechiae
2. vesicels
neutropenic Fever Labs (4)
- CBC
- culture anything possible
- chest xray *, CT, MRI
- LP if meningitis is suspected (platelets!)
Neutropenic fever Tx (3) broad
- assess Low vs. High risk
- obtain cultures
- Begin empiric antibiotic therapy
*complete initial eval and tx within ______ of onset of neutropenic fever
1 hour–abx w/in 1 hour!
neutropenic fever low risk pt’s (8)
- adult
- ANC > 500
- peak temp <39C 102F
- no chemo
- no malignancy
- normal chemistires
- Normal CXR
- No indwelling cath or line
score over ____ = low risk on MASCC sheet
21
High risk pt’s w/ neutropenic fever (11)
- child/elderly >60 yo
- malignancy
- ANC<100
- concurrent chemo and radiotherapy
- DM, poor nutrition
- delayed surgical healing or open wounds
- significant mucositis
- unstable (HTN, oliguric, hypoxic)
- Chronic CS
- indwelling line
- recent hospitalization for infxn
Tx for low risk pts (4)
- oral cipro plus augmentin
- For PCN allergy – oral cipro + clindamycin
- minimum 4 hr observation in ER before discharge
- F/U w/in 24-48 hrs
Fungal Neutropenic fever etiologies (2)
- candiada
2. aspergillus
Tx for high risk N.F. pts
- admit for inpatient
- Gegin monotherapy (anti-pseudomonal)–cephalosporins
- carbapenem–imipenem
- anti-pseudomonal PCN
further Tx for high risk N.F. pts if evidence of pneumonia
add aminoglycoside (tx’s Klebsiella)
Treatment for N.F. if abdominal sx’s present
Metronidazole – suspect C. Diff
If catheter-related infection related to NF tx w/
vancomycin– for MRSA–assume it is pen resistant then move off vanco when culture returns if pen sensitive
for sever mucositis related NF
tx w/ vanco – for S. viridans
If high risk NF pt is vanco resistant tx w/ (3)
- linezolid
- daptomycin
- quinopristin (dalfopristin)
PCN allergy:
- non-anaphylactic tx:
- anaphylactic tx:
- cefepime
2. Aztreonam +/- aminoglycoside or fluoroquinolone
when to stop ABX in NF pt if afebrile by day 3, cultures negative, AND if low risk pt
after 7 days if ANC remains > 500 for 48 hrs
If temp > 3 days, continue ABX until pt fever free AND
ANC > 500 X 5 days
ABX tx if ANC remains <500
minimum of 2 weeks of ABX therapy
when fever > 4-7 dyas and pt anticipated to remain neutropenic for > 7 days consider
fungal infx–> Tx w/ Amphotericin B, Itraconazole
Viral neutropenic fever think (3) Tx.
- HSV
- varicella
- CMV
- -anivirals generally aren’t indicated unless vesicle can be cultured
Gram - neutropenic fever etiologies (4)
- E. coli
- Klebsiella species
- Pseudomonas aeruginosa
- Enterobacter species
Gram + NF etiologies (6)
- S. aureus
- S. epidermidis
- Enterococcus faecalis
- Corynebacterium species
- S. PNEUMONIAE
- S pyogenes
