Infections in Immunocompromised Hosts

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What are the risk factors for developing an infection or becoming an immunocompromised host?
- medical malnutrition
- solid organ transplant
- autoimmune disorders
- bone marrow transplant
- RT
- Corticosteroids
- Cyclosporine
- Tacrolimus
- Etanercept
- Infliximab
- Alemtuzumab
- Fludarabine
- Cladribine
What is nadir?

The lowest WBC count after chemotherapy
What is the equation for ANC?
- WBC x (segs + bands)/100 if percentages
- [WBC x (segs + bands)]/100 if in totals
- [WBC x (PMN + bands)]/100
What organisms are most commonly associated with infection in neutropenic pts?
- S. aureus (and MRSA)
- S. epidermidis (and MRSE)
- Streptococcus spp
- Enterococcus spp
- Corynebacterium spp
- Bacillus spp
- P. aeruginosa
- B. cepacia
- E. coli
- Klebsiella spp
- Acinetobacter baumannii
- Serratia spp
- Enterobacter spp
- Citrobacter spp
- Salmonella spp
- Proteus spp
- Stenotrophomonas maltophila
- Bacteroides spp
- C. difficile
- Fusobacterium spp
- Propionibacterium spp
- Veillonella spp
- Peptococcus spp
- Peptostreptococcus spp
- Candida spp
- Aspergillus spp
- Zygomycetes rhizopus
- Zygomycetes mucor
- Coccidioides spp
- Blastomyces spp
- Histoplasma spp
- Influenza
- Parainfluenza
- HSV
- Vericella zoster
- CMV
- Hep B
- RSV
- P. jirovecii
- T. gondii
What is the prophylactic tx for febrile neutropenic (<500) pts at low risk?
- Cipro + Amoxicillin clavulanate (Clindamycin for Pen allergy)
- Cefepime
- Ceftazidime
- Carbapenem
- AG + Antipseudomonal pen
- AG + Cefepime
- AG + Ceftazidime
- AG + Carbapenem
- Reassess in 3-5d
What is the prophylactic tx for febrile neutropenic (<500) pts at high risk?
- Cefepime
- Ceftazidime
- Carbapenem
- AG + Antipseudomonal pen
- AG + Cefepime
- AG + Ceftazidime
- AG + Carbapenem
- Vanco + Cefepime
- Vanco + Ceftazidime
- Vanco + Carbapenem
- Reassess after 3-5d
What's the next step in tx if pt is afebrile after 3-5d with no etiology identified?
- Low risk:
- Cipro + Amox clav (Cefixime for kids)
- High risk: continue same ABX
- Then discharge
What's the next step in tx if pt is afebrile after 3-5d with etiology identified?

Adjust to most appropriate tx
What is the next step in tx if pt is still febrile after 3-5d and no etiology identified?
- Reassess every day 3-5
- Continue initial ABX:
- if no change (also consider stopping Vanco)
- Change ABX:
- if progressive disease
- if criteria for Vanco are met
- Antifungal drug, with or without ABX change:
- if febrile through days 5-7 and resolution of neutropenia is not imminent
How long should ABX tx continue if afebrile by days 3-5?
- 48h after afebrile + ANC at least 500
- 5-7d after afebrile if ANC < 500 and initial risk was low
- continue ABX if ANC < 500 and initial risk was high
How long should ABX tx continue if fever persistant?
- 4-5d after ANC > 500 and reassess
- Reassess after 2wks if ANC < 500, no disease present, and condition is stable

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giddyupp

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Infections in Immunocompromised Hosts

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Infections in Immunocompromised Hosts

Updated

2011-02-18T03:58:58Z

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