neutropenic sepsis

Question 1

define neutropenic fever

Answer 1

infections. Neutropenic fever is defined as an absolute neutrophil count (ANC) of <500 cells/mm3 or <1000 cells/mm3 with an anticipated decline below 500 cells/mm3 over the next 48 hours coupled with the presence of a single temperature of ≥38.3◦C (101◦F) or a persistent temperature of ≥38.0◦C (100.4◦F)

Question 2

is it primarily infectios or non infectious

Answer 2

it is generally infectious

Question 3

role of emperical antibiotics

Answer 3

monotherapy covering gram negative antipseudomonal cephalosporin, beta-lactam, or carbapenem

Question 4

indications of vanco

Answer 4

when gram positive is suspected on the basis of clinical feat
Severe mucositis • Clinical evidence of catheter- related infection • Known colonization with resistant streptococci or staphylococci • Sudden temperature spike of >40°C • Hypotension

Discontinue Vancomycin after 72 hr if cultures negative for coagulase negative staphylococci, methicillinresistant Staphylococcus aureus, or cephalosporin-resistant streptococci

Question 5

role of dual gram neg coverage

Answer 5

If clinically unstable consider adding double Gram negative coverage with aminoglycoside × 72 hr Discontinue aminoglycoside if cultures negative after 72 hr

Question 6

role of emperical anti fungal and anti viral

Answer 6

If blood cultures remain negative and a fever persists for more than 5 days, empiric antifungal therapy is usually warranted to cover mold infections. Empiric antiviral therapy is generally not recommended unless characteristic skin or cutaneous lesions suggestive of HSV or VZV are identified or active influenza has been identified in the community.