Infection and Sepsis Health Article

Prevention

Strategies that can be used to prevent or minimize infection in the neutropenic patient include:

• Identification of patients at highest risk for infection.
• Avoiding practices by health care team members that increase colonization of microorganisms.
• Implementation of fewer invasive procedures when possible.

Specific interventions in the hospital setting that can be used to prevent or minimize infection include:

• scrupulous handwashing by patient, staff, and visitors.
• good personal hygiene, including an oral care protocol by the patient.
• ambulation (movement).
• aggressive efforts to promote lung expansion.
• elimination of uncooked fruits and vegetables from the diet.
• removal of plants and other sources of stagnant water from the patient's room.
• screening and minimizing outside visitors to avoid those with infection

In addition, the hospitalized patient is assessed by the staff at least every four hours and laboratory results are collected and analyzed to determine risk for and presence of neutropenia.

A newer method to prevent infection in the cancer patient works by decreasing the duration of neutropenia. This method decreases the period of maximum risk for infection by using hematopoietic growth factors (HGFs). These growth factors are administered daily beginning 24 hours after chemotherapy, and shorten the duration and severity of neutropenia. Therefore, the period of risk for infection is shortened. HGFs work by activating the production and maturation of RBCs, WBCs, and platelet cell lines. Specific HGFs stimulate the production and maturation of aggressive neutrophils and macrophages, which are effective in destroying pathogens (bacteria or viruses that cause infection or disease).

Sepsis can be avoided by preventing infection in immunocompromised patients and by recognizing risk factors and altering those factors whenever possible.

Treatment

Empiric antibiotic therapy is the mainstay of treatment for infection in the cancer patient. Empiric therapy refers to initiation of antibiotic therapy prior to the identification of the infecting organism. Broad-spectrum antibiotics, antibiotics effective against both gram-negative and gram-positive organisms, are administered. Commonly used agents include aminoglycosides, fluoroquinolones, glycopeptides, and beta-lactams such as penicillins, cephalosporins, carbapenems, and monobactams. Empiric antifungal therapy is initiated five to seven days after empiric antibiotic therapy has been started if the patient remains febrile (with a fever). Antiviral agents may be administered if there is evidence of a viral infection. The Infectious Diseases Society of America recommends a minimum of five to seven days further treatment with parenteral (introduced in other ways than intestinal absorption) antibiotic therapy after the fever resolves (returns to normal). Continued monitoring of bacterial and fungal culture results is essential. This allows the use of more tailored antibiotics for the specific infectious agents.

The neutropenic patient with fever can progress quickly to sepsis and septic shock if left untreated. The patient may also progress to septic shock if empiric antibiotic coverage is inadequate. The most common cause of septic shock in cancer patients is infection with gram-negative bacteria. The management of sepsis and septic shock is considered an emergency situation and includes treatment with broad-spectrum antibacterial coverage and maintenance of ventilation, oxygenation, fluid volume, and cardiac output.

See Also Vascular access

Resources

BOOKS

Freifeld, A. G., T. J. Walsh, and P. A. APizzo. "Infections in the Cancer Patient." In Cancer: Principles and Practice of Oncology. DeVita, V.T., S. Hellman, and S. A. Rosenberg. Philadelphia: Lippincott, 1997, pp.2659-2704.

Schaffer, S. D., L. S. Garzon, and D. L. Heroux, et al. Infection Prevention and Safe Practice St. Louis: Mosby, 1996.

Wujcik, D. "Infection." In Cancer Symptom Management Boston: Jones and Bartlett, 1999, pp. 307-321.

PERIODICALS

Shelton, B. "Sepsis." Seminars in Oncology Nursing 15 (August 1999): 209-221.

Toney, J. F., and M. M. Parker. "New Perspectives on the Management of Septic Shock in the Cancer Patient." Infectious Diseases Clinics of North America 10 (1996): 239-253.

Yoshida, M. "Infections in Patients with Hematological Diseases: Recent Advances in Serological Diagnosis and Empiric Therapy." International Journal of Hematology 66 (1997): 279-289.

OTHER

"Supportive Care for Patients -Fever, Chills, and Sweats."National Cancer Institute CancerNet 16 April 2001 <http://cancernet.nci.nih.gov/coping.html>

Melinda Granger Oberleitner, R.N., D.N.S.

Corticosteroids

—Adrenal cortex steroids.

Central venous catheters

—Devices used for access to the blood stream. The distal tip of the catheter after insertion is located in the superior vena cava, or above the junction of the right atrium. May be used for blood sampling and for the infusion of any type of fluids, medications, nutritional supplements, and blood components.

Gram-negative

—Types of bacteria that do not retain gram stain.

Gram-positive

—Types of bacteria that retain gram stain.