Infections in Immunocompromised Hosts

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  1. What are the risk factors for developing an infection or becoming an immunocompromised host?
    • medical malnutrition
    • solid organ transplant
    • autoimmune disorders
    • bone marrow transplant
    • RT
    • Corticosteroids
    • Cyclosporine
    • Tacrolimus
    • Etanercept
    • Infliximab
    • Alemtuzumab
    • Fludarabine
    • Cladribine
  2. What is nadir?
    The lowest WBC count after chemotherapy
  3. What is the equation for ANC?
    • WBC x (segs + bands)/100 if percentages
    • [WBC x (segs + bands)]/100 if in totals
    • [WBC x (PMN + bands)]/100
  4. What organisms are most commonly associated with infection in neutropenic pts?
    • S. aureus (and MRSA)
    • S. epidermidis (and MRSE)
    • Streptococcus spp
    • Enterococcus spp
    • Corynebacterium spp
    • Bacillus spp
    • P. aeruginosa
    • B. cepacia
    • E. coli
    • Klebsiella spp
    • Acinetobacter baumannii
    • Serratia spp
    • Enterobacter spp
    • Citrobacter spp
    • Salmonella spp
    • Proteus spp
    • Stenotrophomonas maltophila
    • Bacteroides spp
    • C. difficile
    • Fusobacterium spp
    • Propionibacterium spp
    • Veillonella spp
    • Peptococcus spp
    • Peptostreptococcus spp
    • Candida spp
    • Aspergillus spp
    • Zygomycetes rhizopus
    • Zygomycetes mucor
    • Coccidioides spp
    • Blastomyces spp
    • Histoplasma spp
    • Influenza
    • Parainfluenza
    • HSV
    • Vericella zoster
    • CMV
    • Hep B
    • RSV
    • P. jirovecii
    • T. gondii
  5. What is the prophylactic tx for febrile neutropenic (<500) pts at low risk?
    • Cipro + Amoxicillin clavulanate (Clindamycin for Pen allergy)
    • Cefepime
    • Ceftazidime
    • Carbapenem
    • AG + Antipseudomonal pen
    • AG + Cefepime
    • AG + Ceftazidime
    • AG + Carbapenem
    • Reassess in 3-5d
  6. What is the prophylactic tx for febrile neutropenic (<500) pts at high risk?
    • Cefepime
    • Ceftazidime
    • Carbapenem
    • AG + Antipseudomonal pen
    • AG + Cefepime
    • AG + Ceftazidime
    • AG + Carbapenem
    • Vanco + Cefepime
    • Vanco + Ceftazidime
    • Vanco + Carbapenem
    • Reassess after 3-5d
  7. What's the next step in tx if pt is afebrile after 3-5d with no etiology identified?
    • Low risk:
    • Cipro + Amox clav (Cefixime for kids)
    • High risk: continue same ABX
    • Then discharge
  8. What's the next step in tx if pt is afebrile after 3-5d with etiology identified?
    Adjust to most appropriate tx
  9. What is the next step in tx if pt is still febrile after 3-5d and no etiology identified?
    • Reassess every day 3-5
    • Continue initial ABX:
    • if no change (also consider stopping Vanco)
    • Change ABX:
    • if progressive disease
    • if criteria for Vanco are met
    • Antifungal drug, with or without ABX change:
    • if febrile through days 5-7 and resolution of neutropenia is not imminent
  10. How long should ABX tx continue if afebrile by days 3-5?
    • 48h after afebrile + ANC at least 500
    • 5-7d after afebrile if ANC < 500 and initial risk was low
    • continue ABX if ANC < 500 and initial risk was high
  11. How long should ABX tx continue if fever persistant?
    • 4-5d after ANC > 500 and reassess
    • Reassess after 2wks if ANC < 500, no disease present, and condition is stable

Card Set Information

Author:
giddyupp
ID:
67201
Filename:
Infections in Immunocompromised Hosts
Updated:
2011-02-18 03:58:58
Tags:
Infections Immunocompromised Hosts PHPR523 Test3
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Infections in Immunocompromised Hosts
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