Neutropenic Fever Flashcards
Who does neutropenic fever effect?
Arises in cancer pt taking chemo that induces myelosuppression and reduces developmental integrity of GI mucosa
What is fever the earliest sign of infection in neutrophil fever?
Myelosuppression leads to mutated and blunted neutrophil mediated inflammatory response therefore fever is earliest sign of infection
What is the definition of neutropenic fever
Temp above 38.5/101.4 w/ absolute neutrophil count below 500
What are the most common infectious agents involved in neutropenic fever?
Typically nml endogenous flora
Central venous catheters- s aureus, s epidermidis, and klebsiella
Fungal infections- Candida (#1), aspergillus, pneumocystis, and toxo
At what absolute neutrophil count should you avoid rectal exams and for what reason and what result?
No rectal exams if ANC <500
Microscopic tears occur during rectal exams that provides portal for bacteria to enter body and can lead to fulminant sepsis and death w/in 24 hours
Why do you provide primary prophylaxis and for what pt?
Administration of antimicrobials to prevent infections in high risk pt who are expected to be neutropenic <500 for 7 days
Explain primary antibacterial prophylaxis
What do you target
What do you use
What are some AE?
Primary anitbacterial prophylaxis target Pseudomonas and other gram neg bacilli Use fluroguinolones (floxacins) AE- prolonged QT, tendon rupture, inc risk of clostridium difficile infection, and Ab resistance
Describe primary antifungal prophylaxis?
What drug is preferred? What does it protect against? What are its advantages and cautions?
What is an alternative agent? Advantages and cautions?
Primary Antifungal prophylaxis
Fluconazole- provides Candidia prophylaxis; can be give oral or IV, is tolerable, inexpensive, and has few drug interactions; however, its narrow spectrum for Candida and pt can develop resistance
Echinocandins (fungins) are alterative agents that are broader spectrum; however they are expensive and can only be given IV
What is secondary prophylaxis and who uses it?
Secondary prophylaxis is admin of antimicrobials to prevent recurrent infection in pt who have history of fungal infection and are at high risk for recurrent infection
What is the drug used for secondary prophylaxis? What do you avoid giving it with? What is an AE of giving it with a certain drug?
Voriconazole
1st line for aspergillus
Not given w/ certain chemos (rabines) and leads to severe neurotoxicity if given w/ vincristine
What is the strategy for using voriconazole as secondary prophylaxis
Suspend the extended spectrum azole 1 week prior to chemo and start the azole again after the dosing regimen
If you want to continue antifungal treatment during chemo what should you use?
Amphotericin B or achinocandin (fungin)
What is empiric therapy for neutropenic fever?
In general, how long do you give IV antibiotics? What do you do when you reach the goal?
What type of regimen is preferred?
Empiric therapy is admin of antimicrobial agents when a suspected neutropenic fever is occuring
IV antibiotics are given until ANC>1000; once this is achieved you can switch ot oral antiboitics if pt is afebrile and tolerating meals w/o emesis
Combo IV regimen is preferred to single agents
What are the inpatient empiric IV antibiotics used for high risk pt?
Piperacillin and tazobactam
Carbapenems (penems)
Ceftazidime
Cefepime
What do you use if:
Cellulitis or pneumonia?
Gram neg bacteremia?
Abdominal symptoms or suspected C difficile?
Cellulitis or pneumonia- vanco or linezolid
Gram neg- aminoglycoside (amicins)
C difficile- metronidazole
