Wrin - Immunocompromised Patients Flashcards
(33 cards)
What is neutropenia?
-Reduction in the number of circulating neutrophils
-Absolute neutrophil count less than 1000
-Severity, rate of decline, and duration of neutropenia
What are examples of immune system defects?
-Defects in cell-mediated immunity
-Defects in humoral immunity
What protective barriers can be destroyed that would cause someone to be immunocompromised?
-Skin
-Mucous membranes
-Surgery
What are risk factors for infection in an immunocompromised host?
-Neutropenia
-Immune system defects
-Destruction of protective barriers
-Environmental contamination/alteration of microbial flora
Common pathogens that infect neutropenic patients
-S. aureus
-Enterobacterales
-Pseudomonas
-Candida
-Aspergillus
-Zygomycetes
-HSV
-VZV
-CMV
What is cell-mediated immunity?
-T-lymphocytes
-Primary defense against intracellular pathogens
What is humoral immunity?
-B-lymphocytes
-Primary defense against extracellular pathogens
What can cause defects in cell-mediated immunity?
-Defects in T-lymphocyte and macrophage function cause by underlying disease and immunosuppressive drugs
-Reduced ability of host to defend against intracellular pathogens
Common pathogens in people who have defects in cell-mediated immunity
-Listeria
-Nocardia
-Legionella
-Mycobacteria
-C. neoformans
-Candida
-Histoplasma
-PJP
-CMV
-VZV
-HSV
What can cause defects in humoral immunity?
-Defects in B-lymphocyte function caused by underlying disease or immunosuppressive drugs
-Reduced ability of host to defend against extracellular pathogens
Common pathogens in people who have defects in humoral immunity
-S. pneumoniae
-H. influenzae
-N. meningitidis
Common pathogens in patients with skin destruction
-S. aureus
-S. epidermidis
-Candida spp.
Common pathogens in mucous membrane destruction
-S. aureus
-S. epidermidis
-Streptococci
-Enterobacterales
-Pseudomonas
-Bacteroides
-Candida
-HSV
Common pathogens in patients who undergo surgery
-S. aureus
-S. epidermidis
-Streptococci
-Enterobacterales
-Pseudomonas
-Bacteroides
-Candida
-HSV
Which neutropenic patients are at highest risk for invasive fungal infections?
Patients with prolonged neutropenia and on broad spectrum antibiotics or steroids
Clinical presentation of neutropenia associated infections
Presence of fever (most important finding)
What labs and diagnostics must be obtained for patients with neutropenia associated infections?
-Blood cultures
-CBC with differential
-BMP or CMP
-Imaging
-Aspiration or biopsy
What is low risk neutropenia?
-Neutropenia for less than 7 days
-Clinically stable
-Inpatient or outpatient
What is high risk neutropenia?
-ANC less than 100 and neutropenia for more than 7 days
-Clinically unstable
-Inpatient
What is the first-line empiric treatment for febrile neutropenia?
-Cefepime
-Zosyn
What are indications for addition of vancomycin?
-Hemodynamically unstable
-Pneumonia
-Blood cultures growing gram-positive bacteria
-Line/port infection
-SSTI
-Severe mucositis
-Colonization with resistant gram-positive bacteria
What to give a patient if they have a history of type 1 reactions to penicillin
Ciprofloxacin + aztreonam + vancomycin
What are oral antimicrobial regimens for febrile neutropenia?
-Ciprofloxacin + Augmentin (most common)
-Levofloxacin
-Ciprofloxacin + clindamycin
What to give to a patient with febrile neutropenia and MRSA
Vancomycin
