Infectious Diseases and Infection Control in Anesthesia - Immunocompromised Patients
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Immunocompromised patients are at increased risk for community-acquired, nosocomial, and opportunistic infections. Immunocompromise can be due to malignancy, chemotherapy, HIV infection, corticosteroids, severe malnutrition, and immunosuppressive therapy for solid organ and bone marrow transplant recipients or severe autoimmune disease.
- Elective surgery should be delayed if possible in the severely immunocompromised (i.e., total neutrophil count <500 cells/mm3).
- Strict adherence to sterile technique is essential.
- Providers with respiratory infections should not be involved in the care of severely immunocompromised patients. If unavoidable, the provider should wear a surgical mask during any contact with the patient.
- Patients may be on neutropenic precautions that include specific dietary and environmental restrictions as well as the wearing of masks during transport.
- Antibiotic prophylaxis is used in various immunocompromised patients for prophylaxis against postoperative wound infection and for long-term prophylaxis against opportunistic infections. It is important to verify which immunosuppressant drugs a patient is taking as many may interact with common perioperative medications. Cyclosporine, in particular, is associated with metabolism alteration and toxicity when combined with various antibiotics.