wrin Flashcards
what is neutropenia?
reduction in number of neutrophils
ANC <1000
how do you calculate ANC
ANC = WBC x (%polys+%bands)
what ANC is high risk and highest risk
ANC < 500 high risk
ANC < 100 highest risk
duration of neutropenia putting patients at high risk for infection
severe neutropenia > 7 days
risk for neutropenia infection
increased rate of decline
increased duration
broad spectrum antibiotic use or steroids
stem cell patients and chemo patients
defects in cell mediated immunity impact what
primary defense against against intracellular pathogens
T cells
defects in humoral immunity impact what
primary defense against extracellular pathogens
B cells
risk factors for development of infections in immunocompromised patients include
neutropenia
immune system defects
destruction of protective barriers
environmental contamination or alteration of flora
destruction of skin barrier
venipuncture
lines/ports
destruction of mucous membranes
chemotherapy
radiation
when in hospital, oropharyngeal flora switch to what
gram negative bacilii in 48 hours
common bacterial pathogens in immunocompromised patients
staph aureus
enterococcus
pseudomonas
s. epidermis
streptococci
enterobacterales
common fungi pathogens in immunocompromised pathogens
candida
aspergilus
zygomycetes
- mucor, rhizopus
common viruses found in immunocompromised patients
herpes simplex virus HSV)
varicella zoster virus (VZV)
cytomegalovirus (CMV)
presentation of infection in neutropenic cancer patients
fever >38.3 single oral temp
fever >38 for 1 hour +
- careful because other agents could be causing fever (blood products, chemo, drug fever, malignancy)
issues with etiology documenting in neutropenic cancer patients
only microbiologically documented in 30-40% of cases
hard to diagnosie bc we dont have growth in many
low risk neutropenic cancer infection considered what
neutropenia < 7 days
clinically stable
UTI, uncomplicated cellulitis
high risk neutropenic cancer infection considered what
ANC <100 and neutropenia > 7 days
clinically unstable
inpatient, IV
empiric regimens for neutropenic cancer patients need what
pseudomonas coverage
outpatient (low risk treatement) neutropenic infection
ciprofloxacin + amox/clav
ciprofloxacin + clindamycin
levofloxacin
inpatient neutropenic infection treatment
piperacillin/tazobactam
cefepime
imipenem
meropenem
ceftazidime
if penicillin allergy:
- ciprofloxacin + aztreonam + vancomycin
targeted therapy for neutropenia infection MRSA
vancomycin
targeted therapy for neutropenia infection VRE
daptomycin
linezolid
targeted therapy for neutropenia infection ESBL
carbapenem
targeted therapy for neutropenia infection KPC
meropenem/vaborbactam
imipenem/relebactam
ceftazidime/avibactam
targeted therapy for neutropenia infection NDM/IMP/VIM
cefiderocol
if persistent fever with no documented infection after 4 days of broad spectrum what should we do?
anti-fungal therapy
anti-fungal therapy
amphotericin B
azoles
-fungins
if skin or mucosal lesions in febrile neutropenia patients
might be viral, evaulate for VZV, HSV
HSV treatment
acyclovir
valacyclovir
CNV treatment
ganciclovir
famciclovir
most common organisms in catheter related bloodstream infections
staph aureus
s. epidermis
indications for catheter removal
subq tunnel infection
failure to clear blood cultures after 72 hours
persistnet fever
septic embolii
if pathogens present
in patients with ANC <500 and uncontrolled primary disease, sepsis, or multiorgan dysfunction what might be helpful?
CSFs
CSF drugs
filgrastim
sargramostim
do CSFs have benefit in mortality?
no
indications for CSFs
prolonged neutropenia and not responding to antimicrobial therapy
ANC < 500
uncontrolled primary disease
when can vancomycin be used in initial empiric therapy?
hemodynamically unstable
sepsis
pneumonia
gram positive bacteria
line/port infection
SSTI
severe mucositis
who should get prophylaxis for infecction in immunocompromised patients?
ANC < 100 x 7 days
CML,AML, lymphoma
stem cell transplant
alemtuzumab use
prophylaxis treatment for immunocompromised infection
ciprofloxacin
levofloxacin
TMP-SMX
who should get antifungal prophylaxis?
stem cell transplant
induction chemotherapy
antifungal prophylaxis
azoles
-fungins
antiviral prophylaxis used for who
HSV positive patients getting stem cell transplant or leukemia induction
antiviral prophlaxis drugs
acyclovir
annual inactivated flu vaccine
varicella vaccine
