Pathophysiology and microbiology of fever and neutropenia

• Predisposing factors:
  • catheters,
  • skin breakdown,
  • GI mucositis,
  • obstruction (lymphatics, biliary tract, GI, urinary tract),
  • immune defect associated with malignancy
• Often thought due to seeding of bloodstream by GI flora,
  • eg, GNRs (esp. P. aeruginosa)
• Neutropenic enterocolitis (typhlitis):
  • RLQ pain,
  • watery/bloody diarrhea,
  • cecal wall thickening
• Gram ⊕ infections
  • have recently become more common (60–70% of identified organisms)
• Fungal superinfection often results from
  • prolonged neutropenia & antibiotic use