Initial Management
At the onset of FN, where should blood cultures ALWAYS be obtained from?
What is all lumens of the CVL?
What generation cephalosporin is recommended in a patient with high-risk FN?
What is a fourth generation cephalosporin?
In patients responding to antibiotic treatment, when can double gram - coverage be discontinued (if no specific indication to continue combo therapy)?
What is 24-72 hours?
Prolonged FN in high risk patients is defined as lasting how many hours?
What is 96 hours?
What two categories were used for the recommendations?
True or false: a chest x-ray should always be obtained with FN.
What is false? Only with s/s of respiratory illness.
What is an example of a fourth generation cephalosporin?
What is Cefepime?
In a patient with a persistent fever who is clinically unstable, coverage should be broadened to include resistant gram +/- and what other type of bacteria?
What is anaerobic bacteria?
What is the most frequent site of IFD and what imaging should be ordered?
How many changes from the 2017 CPG were included in the 2023 update?
What is two? (earlier discontinuation of empiric antibacterial therapy in clinically well and afebrile patients with low-risk FN if blood cultures remain negative at 48 hours despite no evidence of marrow recovery and pre-emptive antifungal therapy for IFD high-risk patients not receiving antimold prophylaxis)
When should peripheral blood cultures be obtained in a patient with FN?
What is may be obtained at same time as central line cultures; this recommendation is conditional.
When should a second gram - agent be used?
What is a high risk patient who is clinically unstable or when a resistant infection is suspected?
When should a patient with a persistent fever not have coverage broadened?
What is if they are clinically stable?
In IFD high risk patients with prolonged FN & unresponsive to antibiotics, what antifungal should be initiated?
What is caspofungin or liposomal amphotericin B?
A 9-year-old w/ ALL presents with temp 38.6 C & neutropenia. They have a double lumen CVL, are clinically stable, and have no URI symptoms. What diagnostic should be performed immediately?
What is obtain blood cx from both CVL lumens?
When is a urinalysis and urine culture indicated?
What is when a clean-catch/mid-stream sample is readily availbale.
What other antimicrobials can be used in high risk FN aside from 4th generation cephalosporin?
What is a B-lactam or carbapenem?
In both high and low risk patients, how long do they need to be afebrile for to consider discontinuation of anitbiotic therapy?
What is 24 hours?
What is true?
A 6-year-old patient cancer and low-risk FN has been receiving inpatient IV antibiotic therapy. At 48 hours, she is clinically stable, hemodynamically appropriate, and has been afebrile for 24 hours. Blood cx remain negative. However, the ANC has not yet recovered. What management step should be taken?
What is consider discontinuing empiric antibiotic therapy? (2023 update includes dc'ing at 48 hours without marrow recovery)
Why are obtaining urine cultures (esp. before antibiotic administration) not a strong recommendation?
What is that empiric regimens may provide sufficient therapy; UTis often asymptomatic (based on systematic review)?
True or false? Low risk FN patients require inpatient antimicrobial treatment.
In both high and low risk patients, how long do cultures need to remain negative for to consider discontinuation of anitbiotic therapy?
What is 48 hours?
What is acute myeloid leukemia, high-risk acute lymphoblastic leukemia or relapsed acute leukemia; those with prolonged neutropenia; those receiving high-dose steroids; and those undergoing allogeneic HCT in the first year after HCT without evidence of T-cell reconstitution, or receiving steroids or multiple immune suppressive agents to prevent or treat graft versus-host disease
A child with FN remains febrile after 36 hours of IV antibiotics but has no new symptoms and is clinically stable. What should you NOT do based on the fever alone according to the guidlines?
What is broaden the antibiotic regimen?