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
1. soft tissue infections
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?
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?