Nancy L. Stitt, RN, BSN

Disclosures

April 03, 2003

Infection

Transplantation of solid organs has become a widely accepted, widely utilized, and successful modality for treatment of end-stage organ diseases. Improved techniques for organ preservation, surgical procedures, rejection management, and posttransplant infection prophylaxis and treatment have contributed to this success. Most identifiable of the advances in solid organ transplantation (SOT) is the development of potent immunosuppressive agents. However, the use of these agents in the prevention and management of rejection is closely interrelated to the development of infection.

Significant improvements in the management of posttransplant infections have been made over the past 2 decades. The development of prophylactic strategies for bacterial, viral, fungal, and protozoal organisms has contributed to a decrease in infectious complications and an increase in patient survival. The development of drugs with increased antimicrobial activity, improved pharmacokinetic profiles, decreased interactions with other medications, and decreased side effects makes the treatment of infection even more successful. However, the development and emergence of antimicrobial-resistant microbes (eg, vancomycin-resistant enterococci [VRE], methicillin-resistant Staphylococcus aureus [MRSA], penicillin-resistant pneumococci, ganciclovir-resistant cytomegalovirus [CMV], and azole-resistant Candida species); fungi (eg, Fusarium, Alternaria,and Scedosporium); and opportunistic bacteria (eg, Rhodococcus equi and Nocardia species) is the price paid for prophylactic, preemptive, and therapeutic use of antimicrobial agents over the years. All contribute to pre- and posttransplant morbidity and mortality and thus complicate the posttransplant recovery course.

The emergence of the human polyomaviruses also contributes to the challenge of caring for renal transplant recipients. Strategies to win the war against transplant rejection will always be a priority, but battles against infection must be fought and won as well. Thorough pretransplant screening in both the organ donor and recipient is imperative. Posttransplant infection prophylaxis, combined with early identification and treatment strategies for infection, is key to decreased length of stay, diminished cost, and increased patient survival.

The objectives for this chapter are to:

 

  • Summarize the issues relevant to the problem of infectious complications in SOT recipients

  • Differentiate between infection in the immunocompetent vs the immunocompromised host

  • Define opportunistic infection

  • Describe the epidemiology of infection in SOT recipients

  • Outline recent advances in prevention and treatment of posttransplant infection

  • Discuss key clinical considerations in the clinical management of immunosuppressed transplant recipients.

 

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