Exam 5 - Immunocompromised Host

Question 1

Neutropenia = an ________ less than _______/mm3

Answer 1

an ANC (absolute neutrophil count)
less than 1000

Question 2

how to find ANC?

Answer 2

WBC x (% polys + % bands)

Question 3

what are important risk factors related to neutropenia

Answer 3

severity of neutropenia
rate of neutrophil decline
duration of neutropenia

Question 4

High risk of infection in pts with ANC < _______

Answer 4

500 cells/mm3

Question 5

Risk of infection and death are greatest in pts with ANC < ________

Answer 5

100 cells/mm3

Question 6

Cell mediated or Humoral immunity defects?

defects in t lymphocyte and macrophage

Answer 6

cell mediated

Question 7

Cell mediated or Humoral immunity defects?

defects in B cell function

Answer 7

humoral

Question 8

Cell mediated or Humoral immunity defects?

results in reduced ability of the host to defend against intracellular pathogens

Answer 8

cell mediated

Question 9

Cell mediated or Humoral immunity defects?

common bacteria pathogens found include ATYPICALS! (listeria, nocardia, legionella, mycobacteria)

Answer 9

cell mediated

Question 10

Cell mediated or Humoral immunity defect?

common pathogen = fungi

Answer 10

cell mediated

Question 11

Cell mediated or Humoral immunity defects?

common pathogens include S. pneumoniae, H. influenzae, N. meningitidis

Answer 11

humoral

Question 12

most infections in cancer patients are caused by oraganisms that are colonized where?

Answer 12

skin
oropharynx
and GI tract

Question 13

Clinical presentation in neutropenic patients?

Answer 13

presence of fever - probably ONLY clinical finding

wont see white cells because they are NEUTROPENIC!!

Question 14

Patient factors for being low risk for infections:

• neutropenic for < ____ days
• no or few ____________
• clinically stable at ________
• no identified focus of infection/simple infection

Answer 14

• neutropenic for < 7 days;
• comorbidities
• onset of fever

Question 15

Patient factors for being high risk for infections:

• profound/prolonged _________
• significant ________

Answer 15

• neutropenia = ANC < 100 and > 7 days

- comorbidities

Question 16

If pt is low risk for infection and has neutropenia:

if pt has adequate outpt infrastructure (phone and transport) AND can do oral regimen…. what do you give them

Answer 16

cipro + amox/clav

Question 17

If pt is low risk for infection and has neutropenia:

if pt has INadequate outpt infrastructure (phone and transport) OR can NOT do oral regimen…. what do you give them

Answer 17

IV abx MONOTHERAPY

Question 18

what are the IV abx that are used in febrile neutropenic patients – LOW RISK

Answer 18

pip/tazo
antipseudomonal carbapenem (AKA not erta)
Cefepine
Ceftazidime

Question 19

If pt is high risk for infection and has febrile neutropenic: what do you give them?

Answer 19

IV abx (monotherpapy)

Question 20

what are the IV abx that are used in febrile neutropenic patients – HIGH RISK

Answer 20

same as LOW RISK!!
pip/tazo
antipseudomonal carbapenem (AKA not erta)
Cefepine
Ceftazidime

Question 21

when patient is high risk febrile neutropenia:

add Vanc when?

Answer 21

cellulitis, pneumonia, severe sepsis/shock
known colonization with MRSA or resistant streptococci, or gram POSITIVE bacteremia

*duh no vanc needed for gram -

Question 22

when patient is high risk febrile neutropenia:

if septic shock or gram - bacteremia or pneumonia add what drugs?

Answer 22

add aminoglycosides OR antipseudomonal FQ

consider anti fungal for septic shock

Question 23

if pt has MRSA: consider early addition of what drugs?

Answer 23

vanc, linezolid, or daptomycin

Question 24

if pt has VRE: consider early addition of what drugs?

Answer 24

early addition of linezolid or daptomycin

Question 25

if pt has ESBL: consider early addition of what drugs?

Answer 25

consider early use of carbapenem

Question 26

if pt has KPC producer: consider early addition of what drugs?

Answer 26

colistin in combo

or ceftazidime/avibactam

Question 27

when to add antifungal therapy to neutropenic patients?

Answer 27

when pts remains febrile with undocumented infection after 4 - 7 days of broad spec abx

Question 28

if pt has HSV/VZV — give what drug?

Answer 28

acyclovir

Question 29

if pt has CMV — give what drug?

Answer 29

ganciclovir

Question 30

what neutropenic people need antifungal prophylaxis

Answer 30

people getting allogenic HSCT (hematopoietic stem cell transplant)

pts undergoing intensive remission induction or salvage induction chemo for acute leukemia)

Question 31

when to do antiviral prophylaxis?

Answer 31

acyclovir prophylaxis in HSV seroPOSITIVE pts who are geting a HSCT or leukemia infuction therapy