Term
| How do you calculate ANC? |
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Definition
Total WBC count X percentage of neutrophils
Neutrophils = Segs + Bands
Ex
WBC = 4x10^3
Neutrophils = 20% segs and 5% bands
ANC = 4000 x (0.2 + 0.05) = 1000 |
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Term
| Definition of Neutropenia |
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Definition
- ANC < 500 cells/mm^3
- ANC expected to decrease to < 500 cells/mm^3 during the next 48 hrs
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Term
| Definition of Profound Neutropenia |
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Definition
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Term
| Definition of Functional Neutropenia |
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Definition
- Pts whose hematologic malignancy results in qualitative defects of circulating neutrophils
- Increased risk for infection, despite a "normal" ANC
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Term
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Definition
A single oral temp > 38.3 C (101 F)
OR
A temp > 38 C (100.4) for > 1 hr |
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Term
| The hallmark respone to an infection in a patient with febrile neutropenia is: |
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Definition
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Term
| Primary Sites of Infection in Neutropenia Host |
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Definition
Alimentary Tract
- Chemo-induced mucosal damage allows invasion of opportunistic organisms
Integument
- Damage by invasive procedures often provides portals of entry for infectious organisms
Others include:
- Oropharyngeal
- Lung
- Skin and soft tissue
- Sinuses
- GI tract
- Perirectal
- Catheter sites
- Bacteremia
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Term
| Common Bacterial Pathogens in Neutropenic Patients: Gram Positives |
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Definition
- Coagulase (-) Staphylococci
- Staphylococcus aureus, including MRSA
- Enterococcus species, including VRE
- Viridans group Streptococci
- Streptococcus pneumoniae
- Streptococcus pyogenes
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Term
| Common Bacterial Pathogens in Neutropenic Patients: Gram Negatives |
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Definition
- Escherichia coli
- Klebsiella pneumoniae
- Enterobacter species
- Pseudomonas aeruginosa
- Citrobacter species
- Acinetobacter species
- Stenotrophomonas maltophilia
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Term
| Drug-Resistant G(-) causing an increased number of infections in Neutropenic Patients |
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Definition
ESBL-Producing Organisms
- Klebsiella species
- E. coli strains
Carbapenemase-Producing Strains
- Klebsiella species
- Pseudomonas aeruginosa
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Term
| In neutropenic patients, fungal infections are typically encountered when? |
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Definition
| After the first week of prolonged neutropenia and empiric antibiotics |
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Term
| Common Fungal Infections in Neutropenic Patients |
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Definition
Yeasts
- Candida species
- Superficial infections of mucosa (thrush)
- Bacteremia secondary to mucositis
- Deep tissue candidiasis
Molds
- Aspergillus species
- Most likely to cause life-threatening infection of the sinuses and lungs
- Typically develop after > 2 weeks neutropenia
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Term
| Patients at HIGH RISK for Neutropenic Fever |
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Definition
- Anticipated prolonged (> 7 days duration) and profound neutropenia (ANC < 100)
AND/OR
- Significant co-morbid conditions such as: hypotension, pneumonia, new-onset abdominal pain, neurologic changes
- MASCC score < 21
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Term
| In general, where and how can patients at HIGH RISK for Neutropenic Fever be treated? |
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Definition
| Admit to hospital for empirical therapy |
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Term
| Patients at LOW RISK for Neutropenic Fever |
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Definition
- Anticipated brief (< 7 days duration) neutropenic period
- No/few co-morbidities
- MASCC score > 21
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Term
| In general, where and how can Patients at LOW RISK for Neutropenic Fever be treated? |
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Definition
| Outpatient and/or oral empirical therapy |
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Term
| High Risk Empiric Antibiotics for the general patient |
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Definition
Antipseudomanl Beta Lactams
- Cefepime
- Meropenem
- Imipenem-Cilastatin
- Piperacillin-Tazobactam
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Term
| High Risk Empiric Antibiotics for patients with suspected catheter-related infection, skin/soft tissue infection, pneumonia, or hemodynamic instability |
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Definition
Anti-Pseudomonal Beta Lactams
AND
Vancomycin |
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Term
| High Risk Empiric Antibiotics for patients with previous infection or colonization with MRSA |
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Definition
Anti-Pseudomonal Beta Lactams
AND
Vancomycin, Linezolid, or Daptomycin |
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Term
| High Risk Empiric Antibiotics for the patients with previous infection or colonization with VRE |
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Definition
Anti-Pseudomonal Beta Lactams
AND
Linezolid or Daptomycin |
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Term
| High Risk Empiric Antibiotics for patients with previous infection or colonization with ESBLs |
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Definition
| Anti-Pseudomonal Carbapenem (Meropenem, Imipenem-Cilastatin) |
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Term
| High Risk Empiric Antibiotics for patients with previous infection or colonization with Klebsiella pneumoniae carbapenemase (KPC) |
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Definition
Anti-Pseudomonal Beta Lactam
AND
Polymyxin-Colistin or Tigecycline |
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Term
| Initial PO/IV doses of Empiric Antibiotics for Low Risk patients should be administered where? |
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Definition
In clinic or hospital setting
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Term
| For Low Risk patients, they can be transitioned to outpatient PO or IV if: |
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Definition
- Vigilant observation and prompt access to appropriate medical care must be ensured 24/7
- Preferably located within 1 hr of medical facility
- Patients that develop recurrent fever or new signs of infection must be admitted and empiric IV antibiotics initiated
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Term
| Adult Regimen of Antibiotics for Low Risk Febrile Neutropenia |
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Definition
| Amoxicillin/Clavulanate + Ciprofloxacin |
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Term
| If a Low Risk patient is receiving fluoroquinolone prophylaxis, what other antibiotic should they receive for febrile neutropenia episodes? |
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Definition
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Term
| Antibiotic Prophylaxis is recommended for High or Low Risk Patients? |
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Definition
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Term
| Which antibiotics are used for prophylaxis in Neutropenic Fever? |
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Definition
Levofloxacin or Ciprofloxacin
Levofloxacin is preferred over Cipro for mucositis, because Levo has better G+ coverage |
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Term
| When should empirical antifungal therapy be considered in Neutropenic Fever? |
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Definition
Considered for patients with:
Persistent recurrent fever after 4-7 days of antibiotics
AND
Overal duration of neutropenia is expected to be > 7 days
NOT recommended for Low Risk patients |
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Term
| Anti-Candida prophylaxis is recommended in Neutropenic patients with: |
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Definition
High risk of invasive candidal infection such as:
HSCT recipients
Intensive remission-induction or salvage chemotherapy |
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Term
| Anti-Candida prophylaxis agents |
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Definition
- Fluconazole
- Itraconazole
- Voriconazole
- Posaconazole
- Micafungin
- Caspofungin
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Term
| Anti-Aspergillus prophylaxis is recommended in Neutropenic patients that are: |
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Definition
- > 13 yo undergoin intensive chemo for AML/MDS
- Allogenic or autologous transplants recipients
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Term
| Acyclovir prophylaxis is recommended for Neutropenic patients with: |
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Definition
| HSV + patients undergoing allogeneic HSCT or Leukemia induction therapy |
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Term
| Acyclovir treatment is recommended for Neutropenic patients with: |
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Definition
| HSV or VZV active infection |
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