Immunocompromised Patients

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.

1. Elective surgery should be delayed if possible in the severely immunocompromised (i.e., total neutrophil count <500 cells/mm³).
2. Strict adherence to sterile technique is essential.
3. 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.
4. Patients may be on neutropenic precautions that include specific dietary and environmental restrictions as well as the wearing of masks during transport.
5. 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.