Neutropenic Fever Flashcards
Neutrophils attack______!!!
Bacteria!!
Neutrophils stain______. First to arrive on site of ______. Attack cells that are ______. Can be elevated from _______, surgical stress, ______, and corticosteriods.
nuetral, injury, marked, infection, trauma
Fever in nuetropenic patients:
- Single oral temp of >38.3 (101)
- Temp of >38.0 (100.4) on 2 occasions
Nuetropenia
Severe = ANC <100 cells
ANC (absolute neutrophil count) calculation
ANC = Total WBC x % nuetrophils
Causes of neutropenia
- Increased utilization of neutrophils = SEPSIS
2. Decreased Production = leukemia, drugs, HIV
Initial Eval of pt with suspected neutropenia
- Hx: Underlying disease, transplant, chemotherapy, drug hx
2. Culture everything!! Wounds, lines, caths etc.
Treatment
- Obtain culture before giving ABX
- Treat Empirically within the hour!!
(70% of pts that aren’t treated within the hr of arriving in ER die…)
Low Risk pts and Treatment
- Adults with ANC >500cells, no comorbidities
- Oral ciprofloxacin plus amoxicillin/clavulanate
High Risk pts and Treatment
- Adults with ANC <100cells, comorbidities
- Admit inpatient
- Begin Monotheraphy: Extended Spectrum ABX = Anti-pseudomonal
i. Cephalosporin
ii. Carbapenem
iii. Anti-Pseudomonal PCN
Caveats to Tx (3)
i. Add aminoglycoside if evidence of pneumonia or Gram (-) infection
ii. Add Metronizadole (Flagyl) for abd. Symtpoms and suspected C. Diff.
iii. Give Vanco for suspected cather-related infection
When to stop treatment?
If afebrile, neg culture, low risk pt, ANC >500cells for 48hrs
When to begin antifungals?
When fever >4-7 days and pt anticipated to remain neutropenic for >7days. Consider anti-fungal therapy.
Antivirals?
NO DRUGS RECOMMENDED unless evidence of viral infx.
