Laura Zitella, a nurse practitioner in the division of oncology at Stanford Hospital and Clinics in California recently spoke at the 38th Annual Oncology Nursing Society Congress, on the best practices in infection risk, prevention and management.
She points out that “the depth and breadth of neutropenia correlate with the risk of infection. So there are very solid guidelines for the prevention of neutropenic-related infections, using interventions such as growth factors.”
“I think that now that we have so much more information about the risks for infection and what we can do to prevent them, the recommendations are very specific—and so it’s important to know your patient; know what patient-related risk factors they have, like comorbidities; the disease-related risk factors (solid tumor vs lymphoma or leukemia); and the treatment-related risk factors, which would be the myelosuppressive nature of the chemotherapy, or the immunosuppressive effects of the therapy, or bone marrow transplant.”
“In the bone marrow transplant (BMT) setting, there’s a really nice set of guidelines that was published in 2009, and that was a compilation, a consensus of guidelines, from American Society for Blood and Marrow Transplantation (ASBMT), the Infectious Diseases Society of America (IDSA), and the Canadian Infectious Disease Society, and a number of other organizations, and that is extremely comprehensive. It covers just about every known pathogen that can affect bone marrow transplant patients. Other useful guidelines would be the IDSA febrile neutropenia guidelines, which were published in 2011; and the American Society of Clinical Oncology Clinical Practice Guidelines on antibiotic prophylaxis and febrile neutropenia in outpatients, which was just published a few months ago; and there are also guidelines for the prevention of central line infections, which is also a significant issue in our patient population.”
Ariana-Leilani is severely neutropenic, but is not receiving GCSF to help prevent infection.
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Read More: ONS: Infection