Y5 - Neutropenic Sepsis

Question 1

what is neutropenic sepsis also called

Answer 1

febrile neutropenia

Question 2

def

Answer 2

fever >38 for 1 hour with an absolute neutrophil count of <500cells/microlitre

Question 3

what is the most common life threatening complication of cancer therapy

Answer 3

febrile neutropenia

Question 4

epi

Answer 4

most common life threatening complication of cancer therapy

very common in haematological malignancies

Question 5

aetiology

Answer 5

common complication of chemotherapy (esp of haematological malignancies)

Question 6

pathogenesis

Answer 6

occurs when a patient with neutropenis develops an infection

Question 7

what is a major source of pathogens in febrile neutropenia

Answer 7

host endogenous flora

Question 8

risk factors

Answer 8

elderly
low albumin
co-morbidities (other organ failure)
anaemia

Question 9

what are features of febrile neutropenia

Answer 9

recent chemotherapy

symptoms and signs of sepsis (fever, tachycardia, hypoytension)
other symptoms related to infection (N+V+D, cough, SOB, dysuria)

Question 10

what malignancies are most associated with febrile neutropenia

Answer 10

haematological

Question 11

investigations

Answer 11

1 bloods
-FBC (absolute neutrophil count <500cells/microlitre)
2 blood cultures
-positive for a pathogen

Question 12

what respiratory infection is very common with neutropenic sepsis

Answer 12

pneumonia

Question 13

why is neutropenic sepsis so important

Answer 13

it is the most common life-threatening complication of chemotherapy

Question 14

what % of deaths is neutropenic sepsis responsible for

Answer 14

50% of deaths for chemotherapy of solid tumours

75% of deaths from chemotherapy for acute leukaemia

Question 15

what should be given immediately in neutropenic sepsis

Answer 15

antibiotics

Question 16

management of medium/high risk

Answer 16

inpatient antibiotics

Question 17

management of low risk

Answer 17

outpatient antibiotics

Question 18

what are the antibiotics given for medium/high risk patients

Answer 18

• ceftazidime (2g IV 8hrs)

- plus vancomycin (1g IV 12hrs) or linezolid (600mg IV 12hrs)

Question 19

when is vancomycin or linezolid also given

Answer 19

if absolute neutrophil count <100 cells/microlitre, with pneumonia, hypotension

Question 20

what are the antibiotics given for low risk patients

Answer 20

amoxicillin/clavulanate (500mg oral TD)
AND
ciprofloxacin (750mg oral BD)

Question 21

what should be done followin antibiotic failure (3-5 days of treatment)

Answer 21

• continue initial antibiotics
• vancomycin/linezolid
• consider antifungals
• consider antibacterials

Question 22

complications

Answer 22

antibiotic induced fungal overgrowth

mortality

Question 23

what is antibiotic induced fungal overgrowth

Answer 23

use of broad spectrum antibiotics can result in fungal overgrowth

Question 24

what infection can occur with antibiotics

Answer 24

c difficile infection

Question 25

prognosis

Answer 25

if untreated in 48hrs 50% mortality

giving antibiotics reduces mortality to 10%

Question 26

what happens to the prognosis with hypotension, bacteraemia, or pneumonia

Answer 26

complications and mortality increase

Question 27

when is empirical vancomycin given

Answer 27

with high rates of MRSA and/or strep viridans