Infections in the Immunocompromised

OVERVIEW

  • immunosuppression is increasingly common in the ICU and in the community
  • due to conditions such as chemotherapy and stem cell transplantation for cancer, solid organ transplantation, and therapies for autoimmune and rheumatological diseases
  • such patients are susceptible to the common pathogens seen as well as opportunistic pathogens

DIAGNOSIS

Inflammatory responses are impaired

  • patients may lack fever
  • may lack localising signs of infection
  • may lack typical radiographic changes e.g. CXR for pneumonia
  • invasive diagnostic tests may be required
  • infection may be difficult to distinguish from rejection and graft-versus-host disease

MANAGEMENT

  • early use of appropriate antibiotics is critical
  • drug interactions and side effects are common
  • patients from endemic areas may have parasitic diseases
  • many viral infections lack effective treatments
  • resistance to antimicrobials is a common problem

References and Links

  • Fishman JA. Infections in immunocompromised hosts and organ transplant recipients: essentials. Liver Transpl. 2011 Nov;17 Suppl 3:S34-7. doi: 10.1002/lt.22378 PMID: 21748845.

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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