Neutropenic Fever/Line Sepsis

Question 0

Neutropenia?

Answer 0

Absolute neutrophil count <500

Question 1

Therapeutic steps for neutropenic fever with line sepsis?

Answer 1

1. Blood cultures
2. Broad-spectrum IV antibiotics
3. Remove vascular catheter

Question 2

Definition of fever?

Answer 2

Temperature > 38 for one hour or more

Question 3

Appearance of
1. soft tissue infections
2. pneumonia
3. meningitis
4. UTI
 in immunocompromise patients?

Answer 3

1. Diminished induration, erythema, purulence
2. No infiltrates on chest x-ray
3. No CSF pleocytosus cytosis
4. No pyuria

Question 4

Most common pathogens in neutropenic patients?

Answer 4

Gram-positives (used to be Gram-negative bacilli, especially pseudomonas)

Question 5

Clues to gram-positive infection? Tx?

Otherwise? Tx?

Answer 5

cellulitis, oral mucositis, presence of catheter (Start vancomycin plus antipseudomonal therapy)

Otherwise suspect gram-negative (Start antipseudomonal monotherapy – cefepime, ciprofloxacin, imipenem)

Question 6

It with antibiotic treatment patients continue to be febrile after 5 to 7 days, consider?

Answer 6

Antifungals: fluconazole or amphotericin B

Question 7

If patient with line sepsis has catheter, should it be removed?

Answer 7

1. If non tunneled or implanted, catheter should be removed
2. For more permanent catheters organism and complications (Endocarditis, septic venous thrombosis) should guide decision to remove

Question 8

Most common organisms causing line infections?

Answer 8

Staph epidermidis > staph aureus

Question 9

Suspect catheter related infection when?

Answer 9

1. Patient has two or more positive blood cultures
2. Clinical manifestations of infection
3. No source of bloodstream infection except for catheter

Question 10

Can salvage catheter if infection is caused by this organism?

Answer 10

Staph epidermidis

Question 11

Preventative measures in patients who are receiving chemo?

Answer 11

1. Pneumococcus and influenza vaccinations
2. G – CSFs to produce neutrophil
3. Oral quinolones to prevent gram-negative infection
4. Antifungal’s to prevent candida