Neutropenic Fever/Line Sepsis Flashcards Preview

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Flashcards in Neutropenic Fever/Line Sepsis Deck (12):

Therapeutic steps for neutropenic fever with line sepsis?

1. Blood cultures
2. Broad-spectrum IV antibiotics
3. Remove vascular catheter



Absolute neutrophil count <500


Definition of fever?

Temperature > 38 for one hour or more


Appearance of
1. soft tissue infections
2. pneumonia
3. meningitis
4. UTI
in immunocompromise patients?

1. Diminished induration, erythema, purulence
2. No infiltrates on chest x-ray
3. No CSF pleocytosus cytosis
4. No pyuria


Most common pathogens in neutropenic patients?

Gram-positives (used to be Gram-negative bacilli, especially pseudomonas)


Clues to gram-positive infection? Tx?

Otherwise? Tx?

cellulitis, oral mucositis, presence of catheter (Start vancomycin plus antipseudomonal therapy)

Otherwise suspect gram-negative (Start antipseudomonal monotherapy – cefepime, ciprofloxacin, imipenem)


It with antibiotic treatment patients continue to be febrile after 5 to 7 days, consider?

Antifungals: fluconazole or amphotericin B


If patient with line sepsis has catheter, should it be removed?

1. If non tunneled or implanted, catheter should be removed
2. For more permanent catheters organism and complications (Endocarditis, septic venous thrombosis) should guide decision to remove


Most common organisms causing line infections?

Staph epidermidis > staph aureus


Suspect catheter related infection when?

1. Patient has two or more positive blood cultures
2. Clinical manifestations of infection
3. No source of bloodstream infection except for catheter


Can salvage catheter if infection is caused by this organism?

Staph epidermidis


Preventative measures in patients who are receiving chemo?

1. Pneumococcus and influenza vaccinations
2. G – CSFs to produce neutrophil
3. Oral quinolones to prevent gram-negative infection
4. Antifungal's to prevent candida

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