Neutropenic Fever Schoenwald (Exam 1)

Question 1

In what patient population does neutropenic fever occur?

Answer 1

Cancer patients undergoing chemotherapy or cytotoxic antineoplastic therapy.

Question 2

Neutropenic fever is usually caused by colonizing bacteria (or yeast) of the _______.
Why?

Answer 2

The GI tract

This is because chemo can disrupt the mucous membranes of the GI tract allowing organisms to enter

Question 3

Which of the following are fevers?
A)A single temperature of 101.5
B)A temperature of 100.2 for 15 minutes, followed by a return to normal temperature
C)A temperature of 100.4 sustained for 1 hour
D)A temperature of 99.9

Answer 3

A and C

A fever is a single temperature above 101F (38.3C) or a temperature of 100.4 F (38C) sustained for one hour

Question 4

An ANC of less then ______ is considered to be neutropenic.

Answer 4

500 cell/microL

Question 5

How do you calculate the ANC?

Answer 5

ANC = Total WBC x (%PMN’s + % bands)

Question 6

Do patients with solid tumors or hematologic cancers have higher risks associated with neutropenic fever?

Answer 6

Hematologic cancers - especially leukemias

Question 7

Does a patient with a MASCC score of 24 have better or worse prognosis than a patient with a MASCC score of 21?

Answer 7

The score of 24 is better than the score of 21. 26 Is the maximum MASCC score, and the higher the better.

Question 8

In the setting of neutropenic fever, what are the most common bacterial pathogens?

Answer 8

Gram - rods: pseudomonas.

Gram + organisms: Staph epidermidis

Question 9

In the setting of neutropenic fever, what are the most common fungal pathogens?

Answer 9

Aspergillus and Candida species

Question 10

What antiviral prophylaxis is recommended in patients undergoing hematopoietic stem cell transplant or leukemia induction therapy? What is it used to prevent?

Answer 10

Acyclovir to prevent reactivation of herpes simplex virus.

Question 11

T/F? It is important to preform a DRE in patients with neutropenic fever.

Answer 11

False - DRE’s should be avoided due to the high risk of introducing infection.

Question 12

Name some common sights of infection in a patient with neutropenic fever.

Answer 12

Lungs, indwelling ports/IV catheters, skin and mucous membranes

Question 13

What is the first lab to order on a patient with neutropenic fever?

Answer 13

Blood cultures x 2 sets

Question 14

How should the blood cultures be drawn if the patient has a central catheter?

Answer 14

One set of cultures should be drawn from the line, and the other from a peripheral site.

Question 15

What other labs might you consider ordering in a patient with neutropenic fever?

Answer 15

CBC, CMP, UA with culture, sputum culture if cough present, stool culture with C diff testing if diarrhea present, CSF if headache and nuchal rigidity present

Question 16

What imaging should be ordered for low risk neutropenic patients? High risk neutropenic patients?

Answer 16

Low risk: Chest XR

High risk: Chest CT, CT other sites based of symptoms/risk factors

Question 17

When should antibiotics be started after discovering a patient has neutropenic fever?

Answer 17

ASAP

If delayed by even 1 hour, studies show up to 70% mortality

Question 18

What is the empiric tx for low risk neutropenic fever patients?

Answer 18

Ciprofloxacin 500mg PO qd or Levofloxacin 750mg PO qd
AND
Amox/clav 500/125 mg PO TID

Question 19

What is the most commonly utilized empiric tx for neutropenic fever in high risk pts?
What are some other options?

Answer 19

Most common: cefepime 2g IV q12 hours
Other options: Ceftazidime, piperacillin/tazobactam, imipenem, meropenem.
Remember, you’re trying to treat pseudomonas