By Robert H. Rubin
"Infection within the Compromised Host" has develop into a vintage bankruptcy in textbooks dedicated to infectious illnesses and inner drugs. The numbers of compromised hosts are expanding within the period of modem medication as a result of our extended features to accommodate tricky illnesses, particularly neoplasms. to that end, microbiologic problems on the topic of the in depth care administered to those sufferers are expanding to boot. less than those circum stances, not just does the underlying affliction create stipulations favorable for the advance of surprising infections, yet usually the treatment contributes to the purchase of capability pathogens that become brokers chargeable for serious and regularly deadly affliction. Granulocytopenia and immunosuppression were the 2 key fac tors in predisposing sufferers with melanoma and different severe illnesses to serious bacterial infections. Colonization through hospital-acquired pathogens and breaks within the anatomic barriers-as due to the disorder or scientific intervention-have contributed to the excessive occurrence of infectious ailments in those sufferers. even supposing there's a few overlap among the kinds of an infection in granulocytopenic and immunosuppressed hosts, every one ofthese medical entities has certain good points thatjustify contemplating them individually, booking the time period immunocompromised hosts merely whilst refer ring to sufferers who're predisposed to opportunistic infections. for roughly twenty years, infections in granulocytopenic sufferers have attracted the atten tion of clinicians simply because they symbolize a version for the research of antimicrobial medicinal drugs in hosts disadvantaged of a necessary portion of protection opposed to bacterial an infection, that's, an enough variety of usually functioning granulocytes.
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Additional resources for Clinical Approach to Infection in the Compromised Host
Most staphylococcal skin leisions occurring at sites of skin trauma tend to occur in patients who have nasal colonization with this organism. Candida pharyngitis and esophagitis occur more frequently in patients heavily colonized with Candida species in the oral cavity, 16 and some cases of Aspergillus flavus pneumonia have been found to be preceded by upper airway or nasal colonization. , the patient with acute nonlymphocytic leukemia receiving induction chemotherapy. This serial information allows the physician to better select empirical antibiotic therapy should fever develop during granulocytopenia.
2. Sources of Acquisition of Exogenous Organisms Of the five Fs (food, fingers, feces, flies, and fomites) traditionally taught to be the source ofbacterial spread within a population, food undoubtedly remains one of the most important. The ingestion of microorganisms by an immunocompromised host whose gut flora may have been temporarily suppres sed by antimicrobial therapy provides an ideal setting for enhancing the colonization with organisms from exogenous sources. The extended suppression of enteric flora through the use of oral nonabsorbable antibiotics sets the stage for colonization ofthe gut by microorganisms resistant to the antibiotics used.
Regular ingestion. If ingestion is discontinued during granulocytopenia, the resultant rapid repopulation of the alimentary canal by aerobic gram- negative bacilli can lead to overwhelming infection. 29 However, it is our belief that in the appropriate patient the benefits outweigh these risks, but a program of surveillance culturing is absolutely essentiaI so that the antibiotic regimen can be adjusted should a resistant organism be acquired. The utilization of oral nonabsorbable antibiotics cannot be considered lightly; it must be instituted only within a setting of appropriate facilities, staff education, and enthusiasm.