It has been a while since I am back for good. Sadly to say that I deferred my clinical exam to next year. Everything happenned for a reason and I had a fruitful break from my daily life. Here I come, fresh and vibrant!!
I just feel like writing something, it is not an update..just to write something that I saw on my table. It is a brief overview of neutropenic sepsis.
Don't you know that about 80% of infections in the neutropenic patient arise from endegenous flora. Bacteria pathogens are the most commonly isolated, in particular:
E.Coli, Pseudomonas, staph aureus, coagulase neg staph, pneumonococcus and other streptococci, Enterococci, enterobacter, Klebsiella and clostridium.
Please remember other pathogens which are of significant important such as aspergillus, candida species and viruses (HSV, VZV,CMV)
Looking for source of infection and source control are the mainstay of management. Infectious focus could only identified in only 30% of patients, therefore a thorough, structured and careful clinical examination is required. Specific infections that must be looked for include mucositis, catheter related infection, pneumonia, skin lesions, perianal abscess, sinusitis, dental abscess and abdominal pathology. A full septic screen is required and this include CXR. There shouldn't be a delay in administering antibiotic or antimicrobial therapy.
Source control is critical. Removal of CVC is required whenever there are clinical signs of CRBSI or suspected organisms are cultured. In septic shock (with hypotension and organ failure), empirical removal of CVC is strongly indicated.
Antimicrobial therapy: Delay in antibiotic therapy is directly correlated with mortality. Empiric antibiotic therapy is indicated for all patients with neutrophil count less than 0.5 or temperature more than 38C. Initial therapy is usually betalactam with antipseudomonal activity. Vancomycin is added if the patient is in shock, MRSA colonised, or has clinical evidence of mucositis or a catheter related infection. Initial antifungal therapy is indicated for bone marrow transplant recipients and for other patients if the febrile neutropenia persists despite 5 days of broad spectrum antibiotic therapy.
G-CSF are generally used for critically ill patients with post chemotherapy neutropenia. G-CSF has been shown to reduce the duration of neutropenia but not influence mortality in a broad population of neutropenic patients, and evidence is lacking for ICU patients. Usually its used is considered for patients with organ failure.
I just feel like writing something, it is not an update..just to write something that I saw on my table. It is a brief overview of neutropenic sepsis.
Don't you know that about 80% of infections in the neutropenic patient arise from endegenous flora. Bacteria pathogens are the most commonly isolated, in particular:
E.Coli, Pseudomonas, staph aureus, coagulase neg staph, pneumonococcus and other streptococci, Enterococci, enterobacter, Klebsiella and clostridium.
Please remember other pathogens which are of significant important such as aspergillus, candida species and viruses (HSV, VZV,CMV)
Looking for source of infection and source control are the mainstay of management. Infectious focus could only identified in only 30% of patients, therefore a thorough, structured and careful clinical examination is required. Specific infections that must be looked for include mucositis, catheter related infection, pneumonia, skin lesions, perianal abscess, sinusitis, dental abscess and abdominal pathology. A full septic screen is required and this include CXR. There shouldn't be a delay in administering antibiotic or antimicrobial therapy.
Source control is critical. Removal of CVC is required whenever there are clinical signs of CRBSI or suspected organisms are cultured. In septic shock (with hypotension and organ failure), empirical removal of CVC is strongly indicated.
Antimicrobial therapy: Delay in antibiotic therapy is directly correlated with mortality. Empiric antibiotic therapy is indicated for all patients with neutrophil count less than 0.5 or temperature more than 38C. Initial therapy is usually betalactam with antipseudomonal activity. Vancomycin is added if the patient is in shock, MRSA colonised, or has clinical evidence of mucositis or a catheter related infection. Initial antifungal therapy is indicated for bone marrow transplant recipients and for other patients if the febrile neutropenia persists despite 5 days of broad spectrum antibiotic therapy.
G-CSF are generally used for critically ill patients with post chemotherapy neutropenia. G-CSF has been shown to reduce the duration of neutropenia but not influence mortality in a broad population of neutropenic patients, and evidence is lacking for ICU patients. Usually its used is considered for patients with organ failure.
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