Term
| Febrile Neutropenia Pathogens |
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Definition
| increasing prevalence of gram-positive; improved abx w/ gram - coverage, abx resistance among gram positives, increased use of central venous catheters, chemo-related mucositis |
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Term
| Febrile Neutropenia most common organisms |
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Definition
| S. aureus; MRSA; coag (-) staphyloccous; strep pneumonia; strep viridans; enterococcus |
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Term
| Febrile neutropenia most common gram-negative rods |
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Definition
| e. coli, klebsiella spp, pseudomonas aeruginosa |
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Term
| Febrile neutropenia: what about fungal organisms? |
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Definition
| assess risks; Prolonged febrile neutropenia (>7 days), broad spectrum abx or steroids (> 6 das), history of fungal infections, bone marrow transplantation, usually don't need to consider until 5-7 days |
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Term
| febrile neutropenia: common fungal infections |
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Definition
| candida spp. 65%; aspergillus spp. 30% (more common in HSCT) |
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Term
| febrile neutropenia: anaerobic bacteria (mixed infections) |
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Definition
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Term
| febrile neutropenia: viral- reactivation of latent infection |
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Definition
| herpes simplex, varicella zoster, cytomegalovirus (CMV) |
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Term
| febrile neutropenia: pneumocystis jiroveci (PCP) |
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Definition
| prolonged neutropenia (> 1 month), allogeneic HSCT, acute lymphocytic leukemia (ALL) |
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Term
| Febrile Neutropenia: General Principles of Treatment |
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Definition
| Chemotherapy dose reduction or delay for the 2nd chemo cycle; infection control; cultures; broad spectrum abx; monitor cultures and response closely; search for source; mortality increases the longer abx are withheld |
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Term
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Definition
| hand washing; IV access care; no fresh fruit or flowers |
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Term
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Definition
| blood cultures x 2 prior to abx, pan-culture: blood, lines, sputum, urine; others if indicated (i.e. stool, infection site) |
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Term
| Broad spectrum antibiotics |
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Definition
| start antibiotics ASAP in full/aggressive doses, adjust for renal/hepatic impairment, up to 70% mortality if delayed |
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Term
| Common Sites of Infection |
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Definition
| lung, pharynx, lower esophagus, perineum, anus, skin, eye, vascular access sites, bone marrow aspiration sites, nail beds |
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Term
| initial regimen: low risk |
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Definition
| oral antibiotics are a possibility: Ciprofloxacin + amoxicillin/Clavulanate |
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Term
| initial regimen: high risk |
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Definition
| IV antibiotics are needed; monotherapy vs dual/combo therapy, addition of vancomycin |
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Term
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Definition
| Profound neutropenia (ANC < 100) anticipated to last for > 7 days); presence of comorbid medical problems; evidence of hepatic or renal insufficiency |
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Term
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Definition
| found most commonly among patients with solid tumors receiving outpatient chemo |
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Term
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Definition
| High risk: profound (<100), prolonged ( > 7-14 days)- Low Risk: ANC > 100, short duration (<7 days) |
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Term
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Definition
| High risk: hematologic, relapsing, allogeneic HSCT; Low Risk: solid tumor, remission, conventional chemo |
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Term
|
Definition
| High risk: substantial, poor performance status; Low RIsk: none |
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Term
|
Definition
| High risk: unstable, poor performance status; Low Risk: stable, no identified focus of infection or simple infection |
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Term
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Definition
| High risk: > 60 years old; Low Risk: < 60 years old |
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Term
|
Definition
| high risk: hospitalize for IV antibiotics; Low risk: PO or IV abx, outpatient therapy if respond |
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Term
| Oral Regimen Inclusion Criteria |
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Definition
| Use only in low risk patients or as step down therapy for moderate risk patients, Patients must be compliant- have a strong support system or caregiver and be in close proximity to hospital |
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Term
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Definition
| Ciprofloxacin 500-750 mg PO BID PLUS Amoxicillin/Clavulanate 500 mg PO q 8 hours |
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Term
| Appropriate IV Monotherapy |
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Definition
| Ceftazidime or CEfepime or Carbapenem (not Ertapenem) or Piperacillin/tazobactam |
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Term
| IV monotherapy Advantages |
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Definition
| comparable efficacy to other regiments, decreased drug toxicities, less expensive |
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Term
| IV monotherapy inclusion criteria |
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Definition
| patients who MRSA is NOT suspected, patients NOT as risk for multi-drug resistant (MDR) bugs |
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Term
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Definition
| limited gram positive coverage, may increase selection of resistant organisms, no additive/synergistic effect, increased colonization |
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Term
| Appropriate Dual IV Therapy |
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Definition
| Aminoglycoside PLUS zosyn or cefepime or ceftazidime OR carbapenem; DO NOT combine 2 beta-lactams |
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Term
| IV Dual Therapy Advantages |
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Definition
| optimal coverage for Pseudomonas aeruginosa, Bactericidal: decreased rate of bacterial resistance; synergistic activity |
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Term
| IV Dual Therapy Inclusion Criteria |
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Definition
| patients at risk for multi-drug resistant (MDR) pathogens |
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Term
| IV Dual Therapy Drawbacks/cautions |
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Definition
| increased risk of renal toxicity, limited gram positive coverage, requires monitoring therapeutic drug levels |
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Term
| Indications for adding vancomycin |
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Definition
| suspected catheter-related infections; positive blood cultures showing gram positives; known colonization with resistant bugs; chemo-related severe mucositis; quinolone prophylaxis prior to febrile neutropenia; hypotension or CV impairment; clinical deterioration or persistent fever |
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Term
| Vancomycin alternatives (not routinely recommended) |
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Definition
| Linezolid (gram positive, including VRE), Daptomycin (covers gram +, including VRE, not for use in pneumonia); Ceftaroline: relatively new cephalosporin, not data on NF |
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Term
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Definition
| fluconazole, voriconazole, caspofungin, ampho B |
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Term
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Definition
| colony stimulating factors (CSF); sitmulates immune system to make neutrophils; believed to decrease duration of feer, severity and extent of neutropenia, decreased hospitalization; CSF is not routinely used as adjunct therapy |
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Term
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Definition
| quinolones, TMP/SMX; 85% infections stem from GI or skin, controversial: efficacy versus resistance |
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Term
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Definition
| should not be used routinely in all pts with neutropenia; Azoles, enchinocandina, camphotericin |
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Term
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Definition
| prevention of neutropenia, is not routinely recommended in neutropenic patients; IF used: do not start until 24 hours after chemo dose |
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