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INFECTIONS IN IMMUNOCOMPROMISED PATIENTS
A. HAEMATOLOGY
1. Any infection in the immunocompromised host is life-threatening and needs immediate attention.
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2. Febrile neutropenia is defined as a temperature of >38.3 C on a single occasion or >38 C over one hour and ANC
(Absolute Neutrophil Count) <500cells/uL or <1000cells/uL in those with anticipated declining counts.
3. Cultures maybe positive in less than 40% of cases.
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4. Patients have impaired inflammatory responses and hence may have no localizing signs. The usual sign is fever>38 C or
hypothermia.
5. The common portals of infection include the oral cavity, gastrointestinal tract, perianal region, lungs and IV lines.
6. Potential pathogens are dependent on the underlying defect, e.g.
Neutropenia Gram –ve organisms, gram +ve organisms, fungi
Hypogammaglobulinemia Encapsulated organisms
Post splenectomy/ hyposplenic patients
Defective cellular immunity Pneumocystis, toxoplasma, fungi, viruses ,
mycobacteria
7. The choice of antibiotic is based on local organisms and sensitivity patterns. The clinical state of the patient, prior infections
with drug resistant bacteria, recent outbreaks e.g. MRSA or multi-drug resistant Enterobacteriaceae, as well as the availability
and cost of the antibiotics.
HPP AMG Infections In Immunocompromised Patients 36
