![Definition and Risk of Infection as Absolute Neutrophil Count Declines ,[object Object],[object Object],[object Object],[object Object],[object Object],Ann Int Med,1966;64:329 Clin Inf Dis, 2002; 34:730-51](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Fever In The Neutropenic Patient
- 1. Evaluation and Management of Fever in the Neutropenic Patient 2003 Kevin P. High, M.D., M.Sc. Associate Professor of Medicine Sections on Infectious Diseases and Hematology/Oncology
- 4. Hemodynamically unstable &/or new organ dysfunction? No Yes Catheter-related erythema/induration, or chills with CVC flushing? Pip-tazo + cipro + vanco ANC > 100 & clinically stable? Quinolone prophylaxis? No Yes No Yes Cefepime* monotherapy Algorithm for Fever/Neutropenia *Note, there are many other regimens; AZM/Clinda, Cipro/ Clinda or Vanc/AZM for severe PCN allergy **If other nephrotoxic meds, consider meropenem or cefepime montherapy Cefepime* + vanco Pip-tazo* + cipro Pip-tazo* + gent**
- 13. Changing Etiology of Infection in Cancer Patients* % of Isolates Year of Study Summarized from Jones, Clin Inf Dis,1999;29:495
- 14. Changing Etiology of Infection in Cancer Patients* % of Isolates Year of Study Summarized from Jones, Clin Inf Dis,1999;29:495
- 15. Resistance (%) in viridans Streptococci Summarized in Clin Inf Dis, 2002; 34:1524-9 0 0 Vanc 7 30 Imipenem 22 ---- Cefepime 56 74 CTZ 40 56 PCN Marron et al. Carratla, et al. Agent
- 16. Response Rates in Trials of Vanco vs. No Vanco Up Front* % Response Type of Standard Therapy Summarized from Feld, Clin Inf Dis,1999;29:503 Note: no mortality difference in any study !!!!!!!!
- 18. Susceptibility Data for Pseudomonas aeruginosa at WFUBMC (2002)
- 19. Susceptibility Data for Staphylococcus aureus at WFUBMC (20 02 )
- 20. Susceptibility Data for Enterococcus spp. at WFUBMC ( 2002 )
- 21. Hemodynamically unstable &/or new organ dysfunction? No Yes Catheter-related erythema/induration, or chills with CVC flushing? Pip-tazo + cipro + vanco ANC > 100 & clinically stable? Quinolone prophylaxis? No Yes No Yes Cefepime* monotherapy Algorithm for Fever/Neutropenia *Note, there are many other regimens; AZM/Clinda, Cipro/ Clinda or Vanc/AZM for severe PCN allergy **If other nephrotoxic meds, consider meropenem or cefepime montherapy Cefepime* + vanco Pip-tazo* + cipro Pip-tazo* + gent**
- 23. Can Antibiotics Be Discontinued in the Face of Continued Neutropenia?* Afebrile in 3-5 days Etiology ID’d Finish course of therapy ANC < 500 ? Clinically well Stop Abxs after afebrile for 5-7 days; change to po; Re-evaluate Yes Cont’ Abxs No mucositis, ANC < 100, unstable vital signs *Clin Inf Dis, 2002; 34:730-51 ANC > 500 Discontinue Abx’s after 48 hours of no fever + ANC > 500
- 25. Causes of Persistent Fever in Neutropenic Patients* *Editorial by Corey and Boeckh, NEJM,2002;346:222-4.