thera final neutropenic fever

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coal
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272084
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thera final neutropenic fever
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2014-05-01 23:18:04
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thera final neutropenic fever
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  1. calculation for ANC
    WBC (x1000)(cells/mm3) x (% Neutrophils + % Bands)
  2. risk factors for neutropenic fever
    • neutropenia
    • immune system disorders
    • destruction of protective barriers
    • environmental contamination
    • alteration of microbial flora
  3. definition levels for neutropenia
    • normal > 1500 cells/mm3
    • neutropenia < 500 cells/mm3
    • profound neutropenia < 100 cells/mm3
  4. some disease state that may show an abnormally high WBC but they may be defective
    • leukemia
    • steroids
    • chemotherapy agents
    • radiation
  5. what is nadir
    the lowest measurement of the cell line prior to reversal and recovery of the cells, usually 7-10 days
  6. some disease states that may put a pt at risk of neutropenic fever because of decrease immunity
    • lhodgkin's
    • transplant
    • multiple myeloma
    • spenectomy
    • CLL (chronic lymphocytic leukemia)
  7. most common cause of acute bacterial infection among neutropenic pts
    • G+ cocci
    • S. aureus
    • S. epidermidis
    • streptococci
    • enterococcus
  8. some G - causative organisms
    • E.coli
    • K. pneumonia
    • P. aeruginsoa
  9. fungal organisms involved in neutropenia
    • candida
    • aspergillus
    • trichosporon
    • fusarium
    • curvularia
  10. parasitic infections
    • pneumocystis jiroveci
    • toxoplasma gondii
  11. prophylaxis treatment of parasitic infection
    bactrim
  12. clinical presentation of febrile neutropenia
    • single oral temperature of >38.3C (101F) in the absence of other causes
    • OR
    • >38C for 1 hour or more
  13. encapsulated organisms
    • S. pneumoniae
    • H. influenzae
    • N. meningitidis
  14. 3 guidelines for empiric therapy of febrile neutropenia
    • monotherapy - anti-pseudomonal beta lactam
    • 2 drug combo - anti-pseudomonal beta lactam + either and aminoglycoside or an anti-pseudomonal quinolone
    • monotherapy or 2 drug combo + vanco
  15. anti-pseudomonal beta lactams for monotherapy
    • cephalosporins: cefepime, ceftazidime
    • carbapenem: imipenem-cilastatin, meropenem, doripenem
    • penicillin: piperacillin-tazobactam
  16. what should not be used as monotherapy empiric treatment
    • ertapenem & tigecycline low P. aeruginosa coverage
    • cipro - poor G+ activity
  17. 4 risk factors to warrant vancomycin as empiric therapy
    • clinically apparent catheter related infection
    • blood Cx + for G+ bacteria prior to ID and sensitivity
    • known colonization w/MRSA or PCN/Ceph resistant pneumococci
    • HoTN or septic shock
  18. organisms caused by contaminated equipment
    • P. aeruginosa
    • L. pneumophila
  19. organisms caused by contaminated foods
    • G (-) bacteria
    • fungi
  20. 2 signs a person has reactivated herpes simplex virus
    • gingivostomatitis
    • genital lesions
  21. factors of low risk pts
    • neutropenia < 7days
    • clinically stable
    • few co-morbidities
    • no S&S of infection other than fever
    • MASCC > 21 pts
  22. factors of a high risk pt
    • neutropenia for > 7days
    • profound neutropenia
    • clinically unstable
    • multiple co-morbidities
    • focal infection
    • high risk tumor
    • MASCC < 21 pt
  23. if a pt is on vanco empirically when would you discontinue
    after 2-3 days no evidence is found of G + infection
  24. when would we escalate therapy
    • persistent fever with deterioration
    •   add vanco
  25. when would we consider antifungal therapy
    persistent fever after 4-7 days of appropriate abx's and neutropenia is expected to go beyond 7 days
  26. if we were going to do fungal therapy what would it be
    • amphotericin B
    • caspofungin
    • voriconazole
  27. when would we consider anti-viral therapy
    pts with vesicular lesions or ulcerative skin or mucosal lesions
  28. if we were going to use anti-viral therapy what would it be
    • HSV or VZV
    •   acyclovir
    •   valacyclovir
    •   famiciclovir
  29. what would we treat citomegallyvirus with
    • ganciclovir
    • valganciclovir
  30. what would we use if acyclovir and ganciclovir resistance occurs
    foscarnet
  31. duration of therapy for low risk pts
    • ANC < 500
    • - blood cultures
    • after 5-7 afebrile days
  32. duration of therapy for profound neutropenia
    continue until ANC > 500 and clinically stable
  33. duration of therapy for persistent neutropenia and febrile but clinically stable, no active infection
    2 weeks
  34. duration of therapy for sinusitis
    10-21 days
  35. duration of therapy for bacterial pneumonia
    10-21 days
  36. duration of therapy for candida
    minimum of 2 wks after 1st (-) blood culture
  37. duration of therapy for apsergillus
    min of 12 wks
  38. duration of therapy for HSV/VZV
    7-10 days
  39. when would we prophylax and with what
    • intermediate to high risk, expected profound neutropenic > 7days, HSCT pts
    • levofloxacin

    low risk cover for viral

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