Neutropenic Fever Flashcards
1
Q
Definition
A
- fever of 101 or above 100.4 for over an hr
AND - ANC < 500
- remember fevers should be taken seriously cause most are immunosuppressed so may not mount a WBC or other signs (inflammatory) of infection
2
Q
Risks for Poor outcome
A
- MASCC Risk index score - high ( < 21) risk; factors:
- mod-severe symptom
- hypotension - SBP <90
- COPD
- hx of fungal infxn (only with hematologic malignancy)
- volume depletion (need IVF)
- already inpt @ onset of fever
- > 60 yo
3
Q
Workup
A
- CBC, CMP, lactate
- Blood cx
- UA with cx
- CXR
- other cx - CSF, wounds, sputum
- viral nasopharyngeal swabs (presenting with flu-like illness)
4
Q
Management
A
- hospitalize for empiric abx therapy (antipseudomonal monotherapy with cefepime or ceftazidime)
- usually not vanc unless catheter related infxn, MRSA, skin/soft tissue - should be discontinued after 2 days if started and blood cx negative, no MRSA
- continue abx until ANC > 500
- after 7d, add antifungal tx
5
Q
Indications for GMCSF and GCSF
A
- usually given prophylactically after chemotx with known high incidence of neutropenic fever
- can give to old pts/pts with high risk comorbidities
- can be given in neutropenic fever w/ high risk of infxn or poor outcome prediction
- USUALLY NOT given even in neutropenic fever - no hard and fast indication
