wrin

Question 1

what is neutropenia?

Answer 1

reduction in number of neutrophils
ANC <1000

Question 2

how do you calculate ANC

Answer 2

ANC = WBC x (%polys+%bands)

Question 3

what ANC is high risk and highest risk

Answer 3

ANC < 500 high risk
ANC < 100 highest risk

Question 4

duration of neutropenia putting patients at high risk for infection

Answer 4

severe neutropenia > 7 days

Question 5

risk for neutropenia infection

Answer 5

increased rate of decline
increased duration
broad spectrum antibiotic use or steroids
stem cell patients and chemo patients

Question 6

defects in cell mediated immunity impact what

Answer 6

primary defense against against intracellular pathogens
T cells

Question 7

defects in humoral immunity impact what

Answer 7

primary defense against extracellular pathogens
B cells

Question 8

risk factors for development of infections in immunocompromised patients include

Answer 8

neutropenia
immune system defects
destruction of protective barriers
environmental contamination or alteration of flora

Question 9

destruction of skin barrier

Answer 9

venipuncture
lines/ports

Question 10

destruction of mucous membranes

Answer 10

chemotherapy
radiation

Question 11

when in hospital, oropharyngeal flora switch to what

Answer 11

gram negative bacilii in 48 hours

Question 12

common bacterial pathogens in immunocompromised patients

Answer 12

staph aureus
enterococcus
pseudomonas
s. epidermis
streptococci
enterobacterales

Question 13

common fungi pathogens in immunocompromised pathogens

Answer 13

candida
aspergilus
zygomycetes
- mucor, rhizopus

Question 14

common viruses found in immunocompromised patients

Answer 14

herpes simplex virus HSV)
varicella zoster virus (VZV)
cytomegalovirus (CMV)

Question 15

presentation of infection in neutropenic cancer patients

Answer 15

fever >38.3 single oral temp
fever >38 for 1 hour +
- careful because other agents could be causing fever (blood products, chemo, drug fever, malignancy)

Question 16

issues with etiology documenting in neutropenic cancer patients

Answer 16

only microbiologically documented in 30-40% of cases
hard to diagnosie bc we dont have growth in many

Question 17

low risk neutropenic cancer infection considered what

Answer 17

neutropenia < 7 days
clinically stable
UTI, uncomplicated cellulitis

Question 18

high risk neutropenic cancer infection considered what

Answer 18

ANC <100 and neutropenia > 7 days
clinically unstable
inpatient, IV

Question 19

empiric regimens for neutropenic cancer patients need what

Answer 19

pseudomonas coverage

Question 20

outpatient (low risk treatement) neutropenic infection

Answer 20

ciprofloxacin + amox/clav
ciprofloxacin + clindamycin
levofloxacin

Question 21

inpatient neutropenic infection treatment

Answer 21

piperacillin/tazobactam
cefepime
imipenem
meropenem
ceftazidime
if penicillin allergy:
- ciprofloxacin + aztreonam + vancomycin

Question 22

targeted therapy for neutropenia infection MRSA

Answer 22

vancomycin

Question 23

targeted therapy for neutropenia infection VRE

Answer 23

daptomycin
linezolid

Question 24

targeted therapy for neutropenia infection ESBL

Answer 24

carbapenem

Question 25

targeted therapy for neutropenia infection KPC

Answer 25

meropenem/vaborbactam imipenem/relebactam ceftazidime/avibactam

Question 26

targeted therapy for neutropenia infection NDM/IMP/VIM

Answer 26

cefiderocol

Question 27

if persistent fever with no documented infection after 4 days of broad spectrum what should we do?

Answer 27

anti-fungal therapy

Question 28

anti-fungal therapy

Answer 28

amphotericin B azoles -fungins

Question 29

if skin or mucosal lesions in febrile neutropenia patients

Answer 29

might be viral, evaulate for VZV, HSV

Question 30

HSV treatment

Answer 30

acyclovir valacyclovir

Question 31

CNV treatment

Answer 31

ganciclovir famciclovir

Question 32

most common organisms in catheter related bloodstream infections

Answer 32

staph aureus s. epidermis

Question 33

indications for catheter removal

Answer 33

subq tunnel infection failure to clear blood cultures after 72 hours persistnet fever septic embolii if pathogens present

Question 34

in patients with ANC <500 and uncontrolled primary disease, sepsis, or multiorgan dysfunction what might be helpful?

Answer 34

CSFs

Question 35

CSF drugs

Answer 35

filgrastim sargramostim

Question 36

do CSFs have benefit in mortality?

Answer 36

no

Question 37

indications for CSFs

Answer 37

prolonged neutropenia and not responding to antimicrobial therapy ANC < 500 uncontrolled primary disease

Question 38

when can vancomycin be used in initial empiric therapy?

Answer 38

hemodynamically unstable sepsis pneumonia gram positive bacteria line/port infection SSTI severe mucositis

Question 39

who should get prophylaxis for infecction in immunocompromised patients?

Answer 39

ANC < 100 x 7 days CML,AML, lymphoma stem cell transplant alemtuzumab use

Question 40

prophylaxis treatment for immunocompromised infection

Answer 40

ciprofloxacin levofloxacin TMP-SMX

Question 41

who should get antifungal prophylaxis?

Answer 41

stem cell transplant induction chemotherapy

Question 42

antifungal prophylaxis

Answer 42

azoles -fungins

Question 43

antiviral prophylaxis used for who

Answer 43

HSV positive patients getting stem cell transplant or leukemia induction

Question 44

antiviral prophlaxis drugs

Answer 44

acyclovir annual inactivated flu vaccine varicella vaccine