Definitions
IDSA criteria
Single oral temp of >= 38.3C (101F) or temp of >38C (100.4F) sustained over 1 hour period
What is a fever in neutropenic patients
An infectious source is identified in what percent of febrile neutropenic episodes
approximately 20 to 30
Most important part of initial assessment
Temperature and ANC
Do this within 60minutes of presentation
This is defined as a ANC < 1500
What is Neutropenia
Bacteremia is documented in what percent of patients
10-25
Pertinent physical exam
What is emphasizing skin, oral cavity, oropharynx, lungs, abdomen, perianal area
Antibiotics in low Risk (MASCC score 21-26) patients
Augmentin plus cipro and then observe for 4 hours
What is the equation to calculate ANC?
What is Total WBC x (% neutrophils + % bands)
Approximately 80 percent of identified infections are believed to arise from?
patient's endogenous flora
Labs
Complete blood count with differential, CMP, 2 sets blood culture, UCx, lactate, RVP, flu swab.
+-Lumbar puncture
Antibiotics in high risk patients w/o signs of severe sepsis
Typically piperacillin-tazobactam or cefepime or meropenem
This is the neutrophil count defined as severe neutropenia
ANC < 500 cells/microL or expected to decrease to <500 cells/microL over the next 48 hours
What are the most common pathogens
gram-positive bacteria. Staphylococcus epidermidis (by far the most common), Staphylococcus aureus, and streptococci
Order these if your are suspicious of a source of infection
imaging
Antibiotics w/ signs of severe sepsis
Add an additional abx to the empiric regimen to cover for pathogen
consider MRSA, C. diff, Pseudomonas coverage
What is profound neutropenia
ANC <100 cells/microL
In high risk patients, which other pathogen is common?
Candida spp and Aspergillus spp
Plain radiographs or CT?
Cnflicting evidence, but in general CT scans over plain radiographs.
When do we initiate antifungals
Antifungals are typically initiated in high risk patients after 4 days of no improvement on antibiotic therapy.