Neutropenic Fever

Question 1

first WBC to arrive to site of injury

Answer 1

neutrophil

Question 2

WBC that can attack up to 1-2 dozen BACTERIA

Answer 2

neutrophil

Question 3

Fever = (2)

Answer 3

1. single oral temp > 38.3C / 101F

2. temp of >38 / 100.4F on 2 occasions separated by 1 hr

Question 4

neutropenia =

Answer 4

ANC < 1500 cells / microL

Question 5

severe neutropenia

Answer 5

ANC < 500 cells or expected w/in 48 hrs

Question 6

profound neutropenia

Answer 6

ANC < 100 cells / mm3

Question 7

ANC =

Answer 7

total WBC X % neutrophils

Question 8

the more lobes (2-4)/bands

Answer 8

the more immature the neutophil–the more acute the infection–Left-shift–bandemia

Question 9

neutropenic fever =

Answer 9

fever in someone w/ neutropenia

Question 10

ANC

Answer 10

absolute neutrophil count

Question 11

Neutropenia causes (2)

Answer 11

1. ^ utilization (sepsis)

2. v production (bone marrow) –leukemia, drugs (CHEMO), HIV

Question 12

Neutropenic fever management

Answer 12

a medical emergency–> immediate ER eval

Question 13

Before antibiotics most neutropenic fever pt’s _____

Answer 13

died

Question 14

Neutropenic Fever initial eval

Answer 14

1. ENSURE HEMODYNAMIC STABILITY
2. History
3. review of histories
4. Focused Exam
5. lines or in-dwelling hardware

Question 15

Splenectomy think (3) w/ neutropenic fever pt’s – Tx accordingly

Answer 15

1. Strep pneumo
2. N. meningitidis
3. H. influenzae

Question 16

for Neutropenic Fever–stay away from ____ _____!

Answer 16

rectal exam!

Question 17

skin exam w/ neutropenic fever may find (2)

Answer 17

1. petechiae

2. vesicels

Question 18

neutropenic Fever Labs (4)

Answer 18

1. CBC
2. culture anything possible
3. chest xray *, CT, MRI
4. LP if meningitis is suspected (platelets!)

Question 19

Neutropenic fever Tx (3) broad

Answer 19

1. assess Low vs. High risk
2. obtain cultures
3. Begin empiric antibiotic therapy

Question 20

*complete initial eval and tx within ______ of onset of neutropenic fever

Answer 20

1 hour–abx w/in 1 hour!

Question 21

neutropenic fever low risk pt’s (8)

Answer 21

1. adult
2. ANC > 500
3. peak temp <39C 102F
4. no chemo
5. no malignancy
6. normal chemistires
7. Normal CXR
8. No indwelling cath or line

Question 22

score over ____ = low risk on MASCC sheet

Answer 22

21

Question 23

High risk pt’s w/ neutropenic fever (11)

Answer 23

1. child/elderly >60 yo
2. malignancy
3. ANC<100
4. concurrent chemo and radiotherapy
5. DM, poor nutrition
6. delayed surgical healing or open wounds
7. significant mucositis
8. unstable (HTN, oliguric, hypoxic)
9. Chronic CS
10. indwelling line
11. recent hospitalization for infxn

Question 24

Tx for low risk pts (4)

Answer 24

1. oral cipro plus augmentin
2. For PCN allergy – oral cipro + clindamycin
3. minimum 4 hr observation in ER before discharge
4. F/U w/in 24-48 hrs

Question 25

Fungal Neutropenic fever etiologies (2)

Answer 25

1. candiada | 2. aspergillus

Question 26

Tx for high risk N.F. pts

Answer 26

1. admit for inpatient 2. Gegin monotherapy (anti-pseudomonal)--cephalosporins 3. carbapenem--imipenem 4. anti-pseudomonal PCN

Question 27

further Tx for high risk N.F. pts if evidence of pneumonia

Answer 27

add aminoglycoside (tx's Klebsiella)

Question 28

Treatment for N.F. if abdominal sx's present

Answer 28

Metronidazole -- suspect C. Diff

Question 29

If catheter-related infection related to NF tx w/

Answer 29

vancomycin-- for MRSA--assume it is pen resistant then move off vanco when culture returns if pen sensitive

Question 30

for sever mucositis related NF

Answer 30

tx w/ vanco -- for S. viridans

Question 31

If high risk NF pt is vanco resistant tx w/ (3)

Answer 31

1. linezolid 2. daptomycin 3. quinopristin (dalfopristin)

Question 32

PCN allergy: 1. non-anaphylactic tx: 2. anaphylactic tx:

Answer 32

1. cefepime | 2. Aztreonam +/- aminoglycoside or fluoroquinolone

Question 33

when to stop ABX in NF pt if afebrile by day 3, cultures negative, AND if low risk pt

Answer 33

after 7 days if ANC remains > 500 for 48 hrs

Question 34

If temp > 3 days, continue ABX until pt fever free AND

Answer 34

ANC > 500 X 5 days

Question 35

ABX tx if ANC remains <500

Answer 35

minimum of 2 weeks of ABX therapy

Question 36

when fever > 4-7 dyas and pt anticipated to remain neutropenic for > 7 days consider

Answer 36

fungal infx--> Tx w/ Amphotericin B, Itraconazole

Question 37

Viral neutropenic fever think (3) Tx.

Answer 37

1. HSV 2. varicella 3. CMV - -anivirals generally aren't indicated unless vesicle can be cultured

Question 38

Gram - neutropenic fever etiologies (4)

Answer 38

1. E. coli 2. Klebsiella species 3. Pseudomonas aeruginosa 4. Enterobacter species

Question 39

Gram + NF etiologies (6)

Answer 39

1. S. aureus 2. S. epidermidis 3. Enterococcus faecalis 4. Corynebacterium species 5. S. PNEUMONIAE 6. S pyogenes