Post-Transplant Infections

Question 1

Post-transplant, what disease do we need to prophylactically treat in allogenic HSCT?

Answer 1

GVHD, graft-versus-host disease

Question 2

What bacterial, viral, and fungal infections do you worry about 0-30 days post transplant?

Answer 2

Surgical wound, IV catheter, UTI, pneumonia, C. diff, HSV, Hep B/C, flu, candida, aspergillus

Question 3

What viral and opportunistic infections do you worry about >180 days post transplant?

Answer 3

Hep B/C, CMV, varicella zoster virus, PCP, TB, toxoplasma

Question 4

Lower level of monocytes can indicate that they are fighting ___ infections

Answer 4

fungal infections

Question 5

ANC

Answer 5

<500

Question 6

Why is neutropenia potentially a problem?

Answer 6

Infection (bacterial infections are very significant)

Question 7

Neutropenic fevers

Answer 7

> 38.3 C of >38 C for over an hour

Question 8

Factors that favor a high risk for severe infection in neutropenic patients:

• ANC 7 days
• Hepatic insufficiency (aminotransferase levels >___x normal)
• Renal insufficiency (CrCl

Answer 8

ANC <100 anticipated to extend > 7 days
Hepatic insufficiency (aminotransferae levels >5x normal)
Renal insufficiency (CrCl <30 ml/min)

Question 9

Bacterial infection prophylaxis

Answer 9

Broad spectrum antibiotics (cephalosporins, fluoroquinolones)
levo, cipro for duration of neutropenia in high-risk
cefepime

Question 10

PCP prophylaxis

Answer 10

Bactrim, pentamidine

Question 11

Viral prophylaxis

Answer 11

acyclovir, valacyclovir

Question 12

Fungal prophylaxis

Answer 12

fluconazole, voriconazole, posoconazole

Question 13

C. diff treatment

Answer 13

vanco or fidaxomicin

Question 14

atypical bacteria (mycobacterium) treatment

Answer 14

azithromycin

Question 15

Prevention of infection of gram-negative organisms such as pseudomonas and e. coli

Answer 15

oral cipro or levo, IVIG depending on serum IgG concentrations

Question 16

Prevention of infection of gram-positive organisms such as streptococcus, enterococcus, and staphylococcus species

Answer 16

Not usually prescribed unless significant risk factors such as chronic GVHD

Question 17

Prevention of infection of mycobacterium avium complex

Answer 17

not usually prescribed unless significant risk factors such as HIV

Question 18

Prevention of infection of mycobacterium tuberculosis

Answer 18

based on screening tests/exposure INH + pyridoxine

Question 19

Treatment for CMV if UL97 mutation is present

Answer 19

ganciclovir + foscarnet

Question 20

Treatment for CMV if UL54 mutation is present

Answer 20

not a lot of options

Question 21

There is a high level of suspicion of viral infections in neutropenic patients (T/F)

Answer 21

True

Question 22

Prevention of infection of HSV, CMV, Epstein-Barr virus, varicella-zoster virus

Answer 22

acyclovir or valacyclovir, ganciclovir or valganciclovir

Question 23

PCP prophylaxis

Answer 23

Bactrim or pentamidine

Question 24

PCP Treatment

Answer 24

Bactrim (high-dose) +/- steroids

Question 25

Aspergillus prevention

Answer 25

voriconazole or posaconazole

Question 26

Candida prevention

Answer 26

fluconazole, itraconazole, voriconazole, posaconazole

Question 27

Prevention of toxoplasma gondii

Answer 27

Bactrim (already being used for PCP)

Question 28

Empiric treatment for high risk neutropenia

Answer 28

Inpatient IV abx:

• Pip-tazo
• Antipseudomonal carbapenem (meropenem or imipenem)
• Cefepime
• Ceftazidime

Add vanco for pneumonia or septic shock