3.2 Febrile Neutropenia - Comeau

from supportive care lecture

name the three kinds of bone marrow suppression that can be caused by malignancy or cancer treatment

anemia

thrombocytopenic

neutropenia

neutropenia is defined as an ANC of ____

<500

neutropenia puts pts at increased risk of _____

infections

what is the formula for ANC?

(% segs + % bands) x WBC

a temp of ____ once can be defined as febrile

101 F

a temp of _____ sustained over an hour can be defined as febrile

100.4 F

febrile neutropenia definition

have a temp of >/= 101 F and ANC < 500

febrile neutropenia can lead to alterations in which barriers of the body?

skin, GIT, lungs

most common organisms that cause febrile neutropenia include…

bacteria, fungus, and viruses

what type of bacteria is mostly associated with causing febrile neutropenia

gram negative

which gram negative bacteria is the most likely cause of febrile neutropenia?

pseudomonas

the MASCC score for febrile neutropenia determines…

eligibility for inpatient or outpatient treatment

a MASCC score of ____ means the pt can be treated outpatient

>/= 21

a MASCC score of >/= 21 means the pt can be treated…

outpatient

outpatient mgmt of febrile neutropenia:

regimen

ciprofloxacin po + augmentin po

outpatient mgmt of febrile neutropenia:

regimen for pt with penicillin allergy

ciprofloxacin po + clindamycin po

outpatient mgmt of febrile neutropenia:

pt should receive first dose inpatient and then observed for _____ in the clinic or ED

4 hours or more

outpatient mgmt of febrile neutropenia:

daily ___ is needed

assessment

outpatient mgmt of febrile neutropenia:

if the fever is not improved in _____ then they need to be admitted to the hospital

3-5 days

outpatient mgmt of febrile neutropenia:

if the fever is not improved in 3-5 days then…

they need to be admitted to the hospital

inpatient mgmt of febrile neutropenia:

must have ____ coverage

antipseudomonal coverage

inpatient mgmt of febrile neutropenia:

treatment options (remember must have pseudomonal coverage)

cefepime

pip+tazo

meropenem

imipenem + tazo

inpatient mgmt of febrile neutropenia:

treatment for pt with penicillin allergy

aztreonam + vancomycin

mgmt of febrile neutropenia:

when would additional antipseudomonal therapy be added?

concern for site specific infections

previous infections not sensitive to current therapy

previous antibiotic use

hemodynamic stability

inpatient mgmt of febrile neutropenia:

when would vancomycin be added?

MRSA or hx of MRSA

sepsis

pneumonia

catheter infection

inpatient mgmt of febrile neutropenia:

site specific therapy- where do anaerobes typically reside?

GIT and mouth

inpatient mgmt of febrile neutropenia:

treatment for anaerobic infection

metronidazole

when can febrile neutropenia treatment be descalated?

if the organism and source is identified and the pt is stable

when should febrile neutropenia tx be escalated?

if pt becomes or is hemodynamically unstable

if resistant organism is identified or is not covered

if persistent fever for 4-7 days on broad spectrum ABX with no positive cultures

what to do if a pt with febrile neutropenia has persistent fever for 4-7 days on broad spectrum ABX with no positive cultures?

give them an antifungal (echinocandin, voriconazole, or ampho B)

when can febrile neutropenia treatment be d/c’d?

ANC >500 on two readings AND ( if the organism is identified and the infection is treated or no source identified)

which medications can mask a fever and should be avoided in patients at risk for febrile neutropenia?

apap

nsaids

any antipyretic

most important method of febrile neutropenia prevention

wash them hands