Neutropenic Fever/Line Sepsis Flashcards Preview

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Flashcards in Neutropenic Fever/Line Sepsis Deck (12)
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0
Q

Neutropenia?

A

Absolute neutrophil count <500

1
Q

Therapeutic steps for neutropenic fever with line sepsis?

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

Definition of fever?

A

Temperature > 38 for one hour or more

3
Q
Appearance of
1. soft tissue infections
2. pneumonia
3. meningitis
4. UTI
 in immunocompromise patients?
A
  1. Diminished induration, erythema, purulence
  2. No infiltrates on chest x-ray
  3. No CSF pleocytosus cytosis
  4. No pyuria
4
Q

Most common pathogens in neutropenic patients?

A

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

5
Q

Clues to gram-positive infection? Tx?

Otherwise? Tx?

A

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

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

6
Q

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

A

Antifungals: fluconazole or amphotericin B

7
Q

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

A
  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
8
Q

Most common organisms causing line infections?

A

Staph epidermidis > staph aureus

9
Q

Suspect catheter related infection when?

A
  1. Patient has two or more positive blood cultures
  2. Clinical manifestations of infection
  3. No source of bloodstream infection except for catheter
10
Q

Can salvage catheter if infection is caused by this organism?

A

Staph epidermidis

11
Q

Preventative measures in patients who are receiving chemo?

A
  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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