Y5 - Neutropenic Sepsis Flashcards

1
Q

what is neutropenic sepsis also called

A

febrile neutropenia

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2
Q

def

A

fever >38 for 1 hour with an absolute neutrophil count of <500cells/microlitre

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3
Q

what is the most common life threatening complication of cancer therapy

A

febrile neutropenia

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4
Q

epi

A

most common life threatening complication of cancer therapy

very common in haematological malignancies

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5
Q

aetiology

A

common complication of chemotherapy (esp of haematological malignancies)

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6
Q

pathogenesis

A

occurs when a patient with neutropenis develops an infection

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7
Q

what is a major source of pathogens in febrile neutropenia

A

host endogenous flora

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8
Q

risk factors

A

elderly
low albumin
co-morbidities (other organ failure)
anaemia

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9
Q

what are features of febrile neutropenia

A

recent chemotherapy

symptoms and signs of sepsis (fever, tachycardia, hypoytension)
other symptoms related to infection (N+V+D, cough, SOB, dysuria)

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10
Q

what malignancies are most associated with febrile neutropenia

A

haematological

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11
Q

investigations

A

1 bloods
-FBC (absolute neutrophil count <500cells/microlitre)
2 blood cultures
-positive for a pathogen

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12
Q

what respiratory infection is very common with neutropenic sepsis

A

pneumonia

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13
Q

why is neutropenic sepsis so important

A

it is the most common life-threatening complication of chemotherapy

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14
Q

what % of deaths is neutropenic sepsis responsible for

A

50% of deaths for chemotherapy of solid tumours

75% of deaths from chemotherapy for acute leukaemia

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15
Q

what should be given immediately in neutropenic sepsis

A

antibiotics

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16
Q

management of medium/high risk

A

inpatient antibiotics

17
Q

management of low risk

A

outpatient antibiotics

18
Q

what are the antibiotics given for medium/high risk patients

A
  • ceftazidime (2g IV 8hrs)

- plus vancomycin (1g IV 12hrs) or linezolid (600mg IV 12hrs)

19
Q

when is vancomycin or linezolid also given

A

if absolute neutrophil count <100 cells/microlitre, with pneumonia, hypotension

20
Q

what are the antibiotics given for low risk patients

A

amoxicillin/clavulanate (500mg oral TD)
AND
ciprofloxacin (750mg oral BD)

21
Q

what should be done followin antibiotic failure (3-5 days of treatment)

A
  • continue initial antibiotics
  • vancomycin/linezolid
  • consider antifungals
  • consider antibacterials
22
Q

complications

A

antibiotic induced fungal overgrowth

mortality

23
Q

what is antibiotic induced fungal overgrowth

A

use of broad spectrum antibiotics can result in fungal overgrowth

24
Q

what infection can occur with antibiotics

A

c difficile infection

25
Q

prognosis

A

if untreated in 48hrs 50% mortality

giving antibiotics reduces mortality to 10%

26
Q

what happens to the prognosis with hypotension, bacteraemia, or pneumonia

A

complications and mortality increase

27
Q

when is empirical vancomycin given

A

with high rates of MRSA and/or strep viridans