Neutropenic fever: Definition, Causes, Symptoms & Managements
In patients with leukemia, chemotherapy induces bone marrow suppression and causes the majority of patients to develop Neutropenia. Because these patients have much immune function, serious infections can be seen without any symptoms other than fever
have. These infections can go on rapidly and can pose a life threat to your patients, so you should be familiar with Neutropenic fever.
Definition
Neutropenic fever is defined as Neutropenic fever when Fever and Neutropenia are simultaneously present. Fever can be diagnosed as Fever when the body temperature above 38 degrees Celsius lasts for more than 1 hour (different standard for each hospital) and Neutropenia when ANC is below 1500.
Symptoms & Causes
Even patients with the same neuroprotective fever have different risks, but the risk is assessed differently depending on the patient's condition and situation. At this time, the MASCC (Multinational Association for Supportive Care in Cancer) is the score. 5 points each when there is no symptoms or mild, systolic blood pressure greater than 90 points, 4 points for COPD, no previous fungal infection history, 3 points for outpatients, moderate symptoms, no dehydration, 2 points for less than 60 years And the total score is calculated. If the score is 21 or more, it belongs to the low - risk group. In summary, based on blood pressure, COPD, history of fungal infections, dehydration symptoms, age, and other patient conditions, the patient's risk is determined to be high or low. In this case, we can see that Neutropenia is a low-risk patient because of the anticipated chemotherapy and the patient's overall condition is good.
Gram (+) bacterial infections are the most common. Enterococcus, S. pneumonia, S. pyogenes and the like are the most representative gram-positive bacteria. Gram negative bacteria include E. coli, Klebsiella, Enterobacter and Pseudomonas. Eighty percent of the infectious agents belong to the endogenous flora. Prior to the 1980s, Gram negative bacteria such as Pseudomonas aeruginosa were the major infectious agents, but in the 2000s Gram positive bacteria predominated. This change is presumed to be due to an increase in the intracavitary inflow of the skin flora due to an increase in the use of the catheter.
Managements
Immediate antibiotic treatment is very important in the treatment of patients with Neutropenic fever. A wide range of antibiotics should be administered within 60 minutes. Even if the bacteria are identified, extensive administration should be performed instead of antibiotic administration to specifically kill the identified bacteria. This is because unspecified bacteria can cause sepsis rapidly. Antibiotic administration is generally
Cephalosporin + Carbapenem + Piperacillin-tazobactam. In addition, Aminoglycoside and Fluoroquinolone may be considered, and Vancomycin, Linezolid, and Daptomycin may also be considered when a hospital infection is suspected. Patients are currently receiving Cephalosporin + Aminoglycoside + Piperacillin-tazobactam and antifungal agents, so they can receive appropriate antibiotics. However, Cephalosporin should be selected as an antibiotic with antipseudomonal activity.
Several studies have reported that the use of G-CSF and GM-CSF in patients with neutropenia reduces the incidence, infection, and admission of neuroprotective fever. However, there is controversy as to whether CSF is effective in the onset of neutropenic fever. In addition, it is considered that the use of G-CSF and GM-CSF is not recommended because of the immunologic phenotyping of CD13 (+), CD33 (+), and anti-MPO (+) in Myeloblast series.
Neutropenia in a patient receiving a hematopoietic stem cell transplant requires special care, first of all, in a clean room with one patient. The continuous circulation of the air filter and positive air should prevent the germ from entering the room and should be strictly guarded when the guardian or doctor enters the room. Neutropenic diets should also be provided for the diet, but less cooked meats and non-pasteurized cheese should be avoided.
have. These infections can go on rapidly and can pose a life threat to your patients, so you should be familiar with Neutropenic fever.
Definition
Neutropenic fever is defined as Neutropenic fever when Fever and Neutropenia are simultaneously present. Fever can be diagnosed as Fever when the body temperature above 38 degrees Celsius lasts for more than 1 hour (different standard for each hospital) and Neutropenia when ANC is below 1500.
Symptoms & Causes
Even patients with the same neuroprotective fever have different risks, but the risk is assessed differently depending on the patient's condition and situation. At this time, the MASCC (Multinational Association for Supportive Care in Cancer) is the score. 5 points each when there is no symptoms or mild, systolic blood pressure greater than 90 points, 4 points for COPD, no previous fungal infection history, 3 points for outpatients, moderate symptoms, no dehydration, 2 points for less than 60 years And the total score is calculated. If the score is 21 or more, it belongs to the low - risk group. In summary, based on blood pressure, COPD, history of fungal infections, dehydration symptoms, age, and other patient conditions, the patient's risk is determined to be high or low. In this case, we can see that Neutropenia is a low-risk patient because of the anticipated chemotherapy and the patient's overall condition is good.
Gram (+) bacterial infections are the most common. Enterococcus, S. pneumonia, S. pyogenes and the like are the most representative gram-positive bacteria. Gram negative bacteria include E. coli, Klebsiella, Enterobacter and Pseudomonas. Eighty percent of the infectious agents belong to the endogenous flora. Prior to the 1980s, Gram negative bacteria such as Pseudomonas aeruginosa were the major infectious agents, but in the 2000s Gram positive bacteria predominated. This change is presumed to be due to an increase in the intracavitary inflow of the skin flora due to an increase in the use of the catheter.
Managements
Immediate antibiotic treatment is very important in the treatment of patients with Neutropenic fever. A wide range of antibiotics should be administered within 60 minutes. Even if the bacteria are identified, extensive administration should be performed instead of antibiotic administration to specifically kill the identified bacteria. This is because unspecified bacteria can cause sepsis rapidly. Antibiotic administration is generally
Cephalosporin + Carbapenem + Piperacillin-tazobactam. In addition, Aminoglycoside and Fluoroquinolone may be considered, and Vancomycin, Linezolid, and Daptomycin may also be considered when a hospital infection is suspected. Patients are currently receiving Cephalosporin + Aminoglycoside + Piperacillin-tazobactam and antifungal agents, so they can receive appropriate antibiotics. However, Cephalosporin should be selected as an antibiotic with antipseudomonal activity.
Several studies have reported that the use of G-CSF and GM-CSF in patients with neutropenia reduces the incidence, infection, and admission of neuroprotective fever. However, there is controversy as to whether CSF is effective in the onset of neutropenic fever. In addition, it is considered that the use of G-CSF and GM-CSF is not recommended because of the immunologic phenotyping of CD13 (+), CD33 (+), and anti-MPO (+) in Myeloblast series.
Neutropenia in a patient receiving a hematopoietic stem cell transplant requires special care, first of all, in a clean room with one patient. The continuous circulation of the air filter and positive air should prevent the germ from entering the room and should be strictly guarded when the guardian or doctor enters the room. Neutropenic diets should also be provided for the diet, but less cooked meats and non-pasteurized cheese should be avoided.
