Care Of Immunocompromised Patients Research Articles

Laboratory-Developed Tests Account for a Small Minority of Tests Ordered in an Academic Hospital System.

To determine the frequency of use of laboratory-developed tests (LDTs) in an academic medical center system. Retrospective analysis of 2021 test order data from an academic medical center (hospital, outpatient clinics, and cancer center) was done. Measures included assay type, assay methodology, regulatory status, test order volume, inpatient vs outpatient setting, and provider medical specialty. Of the 3,016,928 tests ordered in 2021, 2,831,489 (93.9%) were tests cleared, approved, and/or authorized by the US Food and Drug Administration (FDA); 116,583 (3.9%) were LDTs; and 68,856 (2.3%) were standard methods. These test orders were performed using a total of 1,954 distinct assays. Of these, 983 (50.3%) were FDA assays, 880 (45.0%) were LDTs, and 91 (4.7%) were standard methods. Laboratory-developed tests were more commonly ordered in the outpatient vs inpatient setting and represented a higher proportion of the test volume at the cancer center compared with the university hospital (5.6% vs 3.6%, respectively). The top 167 LDT assays accounted for 90% of the LDT volume (104,996 orders). Among the 20 most frequently ordered LDTs were mass spectrometry assays and tests used in the care of immunocompromised patients. Internal/family medicine placed the greatest number of orders (1,044,642) and ordered one of the lowest proportions of LDTs (3.2%). Laboratory-developed tests made up a small percentage of the total laboratory tests ordered within the academic health system studied.

The Evolving Role of the Rheumatology Practitioner in the Care of Immunocompromised Patients in the COVID-19 Era.

The Evolving Role of the Rheumatology Practitioner in the Care of Immunocompromised Patients in the COVID-19 Era.

Adoptive Immunotherapy for Prophylaxis and Treatment of Cytomegalovirus Infection.

Cytomegalovirus (CMV), a member of the Herpesviridae family, is frequent among hematopoietic cell transplant (HCT) and solid organ transplant (SOT) recipients in absence of antiviral prophylaxis, and is a major cause of morbidity and mortality in these vulnerable populations. Antivirals such ganciclovir, valganciclovir, and foscarnet are the backbone therapies, however drug toxicity and antiviral resistance may render these agents suboptimal in treatment. Newer therapies such as letermovir and maribavir have offered additional approaches for antiviral prophylaxis as well as treatment of drug resistant CMV infection, though may be limited by cost, drug intolerance, or toxicity. Adoptive immunotherapy, the transfer of viral specific T-cells (VSTs), offers a new approach in treatment of drug-resistant or refractory viral infections, with early clinical trials showing promise with respect to efficacy and safety. In this review, we will discuss some of the encouraging results and challenges of widespread adoption of VSTs in care of immunocompromised patients, with an emphasis on the clinical outcomes for treatment and prophylaxis of CMV infection among high-risk patient populations.

Prevalence and Clinical Presentation of COVID 19 in Health Care Workers in Two Main Hospitals During the Pandemic in Shiraz, Iran

Background: Given that immunocompromised patients are more at risk for the infection of SARS-CoV-2, epidemiological data are critical for assessing the corresponding prevalence among health care workers (HCWs) and patients at health centers. Objectives: This study aims to investigate the prevalence of SARS-CoV-2 infection among the staff of two hospitals that take care of immunocompromised patients, including pediatrics and adults with special medical conditions. Methods: This cross-sectional study includes all HCWs of the two hospitals; Abu Ali Sina Transplant Hospital (AASTH) and Amir al-Momenin Burn Injury Hospital (AABIH) in Shiraz, southern Iran, conducted from April 11, 2020, to June 16, 2021. The TaqMan real-time PCR assay was used to assess the SARS-CoV-2 infection rate in the suspected HCWs. Results: Out of 1232 sampled HCWs, 694 (56%) were female. Two hundred sixty-five samples (21.5%) and 967 samples (78.5%) were prepared from AABIH, and AASTH, respectively. The results showed that 30% (373) of the clinically suspected employees had positive test results. There was a significant correlation between the risk of exposure to COVID-19 patients and the PCR positivity rate, which could be explained by the fact that 58% of the infected HCWs were in a high-risk group, 20% medium-risk, and the remaining 22% were low-risk (P < 0.0001). The rates of positive cases in females were higher than that among male counterparts (P < 0.05). Conclusions: In order to protect health care workers and reduce the prevalence and transmission of diseases, deficiencies must be identified and eliminated.

Increased viral variants in children and young adults with impaired humoral immunity and persistent SARS-CoV-2 infection: A consecutive case series.

BackgroundThere is increasing concern that persistent infection of SARS-CoV-2 within immunocompromised hosts could serve as a reservoir for mutation accumulation and subsequent emergence of novel strains with the potential to evade immune responses.MethodsWe describe three patients with acute lymphoblastic leukemia who were persistently positive for SARS-CoV-2 by real-time polymerase chain reaction. Viral viability from longitudinally-collected specimens was assessed. Whole-genome sequencing and serological studies were performed to measure viral evolution and evidence of immune escape.FindingsWe found compelling evidence of ongoing replication and infectivity for up to 162 days from initial positive by subgenomic RNA, single-stranded RNA, and viral culture analysis. Our results reveal a broad spectrum of infectivity, host immune responses, and accumulation of mutations, some with the potential for immune escape.InterpretationOur results highlight the potential need to reassess infection control precautions in the management and care of immunocompromised patients. Routine surveillance of mutations and evaluation of their potential impact on viral transmission and immune escape should be considered.

Clinical Implications of Multiplex Pathogen Panels for the Diagnosis of Acute Viral Gastroenteritis.

Acute gastroenteritis remains a significant cause of morbidity and mortality in both high- and low-resource settings. The development of nucleic acid-based testing has demonstrated that viruses are a common, yet often undetected, cause of acute gastroenteritis. The development of multiplex pathogen PCR panels makes it possible to detect these viral pathogens with greater sensitivity and rapidity than with previous methods. At present, there is insufficient evidence to recommend the routine use of these panels for the average patient with acute gastroenteritis. However, there are specific scenarios and patient populations, such as epidemiology/outbreak surveillance, antimicrobial stewardship, and the care of immunocompromised patients, where these tests could be clinically useful today. Further research on the effect of these syndromic panels on provider antibiotic prescribing behavior and patient length of stay will be necessary to know their ultimate role in clinical practice.

Antimicrobial stewardship in transplant patients

To provide an update on the current landscape of antimicrobial stewardship in solid organ transplant (SOT) recipients. Constructing personalized antimicrobial prescribing approaches to avoid untoward consequences of antimicrobials while improving outcomes is an emerging and critical aspect of transplant medicine. Stewardship activities encompassing the specialized interests of transplant patients and programs are evolving. New literature evaluating strategies to optimize antimicrobial agent selection, dosing, and duration have been published. Additionally, consensus guidance for certain infectious clinical syndromes is available and should inform institutional clinical practice guidelines. Novel metrics for stewardship-related outcomes in transplantation are desperately needed. Though exciting new molecular diagnostic technologies will likely be pivotal in the care of immunocompromised patients, optimal clinical adaptation and appropriate integration remains unclear. Important studies understanding the behaviors influencing antimicrobial prescribing in organizational transplant cultures are needed to optimize interventions. Consequences of antimicrobial use, such as Clostridiodes difficile and infections with multidrug-resistant organisms disproportionately affect SOT recipients and are associated with poor allograft and patient outcomes. Application of ASP interventions tailored to SOT recipients is recommended though further studies are needed to provide guidance for best practice.

The perceptions of the care and support services available for nurses caring for patients with hiv/aids in the intermediate hospital oshakati

Purpose: The rationale of thisresearch was to describe the care and support services given to nurses who are responsible for providing care for patients with both the human immunedeficiency virus. Accordingly, the study investigated HIV/AIDS care support preferences for nurses.Method: The study used a descriptive research design. The respondents comprise twenty-four (24) nurses who were conveniently selected from Intermediate Hospital of Oshakati (IHO).The The requisite data was collected via questionnaires, which were distributed to the respondents. The respondents were required to fill in the questionnaires and furnish their views on their perceptions regarding the care and support services available for nurses caring for patients with HIV/AIDS in the Intermediate Hospital Oshakati.Findings: The study revealed a lack of guidance for nurses who provide care for immunocompromised patients. The study also found that the majority of challenge's nurses face in providing care, and support involved emotional pain and under staff.Conclusions: The study concluded that the nurses themselves were both affected and infected by HIV/AIDSbut that these same nurses are expected to provide treatment to patients with HIV/AIDS. Support systems for nurses constitute an extremely important workplace issue, although the nurses conceded that the hospital in question did not have sufficient capacity to provide such support systems.Recommendations: This study suggested that the hospital leadership could function as a team in developing supportive interventions that match the problems/needs identified. Nurses should also takes to take an active role in caring for themselves.

Improving environmental cleaning process in hemodialysis unit at King Saud Medical City

Maintenance of a clean environment at health care facilities is an important factor in reducing the risk of cross Infection. Unmonitored organic residues can build up to high levels on surfaces if adequate cleaning procedures are not adopted. Currently there is no consistent methodology to evaluate environmental cleaning process at king Saud Medical City. Our project aimed to develop monitoring tools to ensure proper surfaces cleaning. Project was implemented at Hemodialysis unit as it provides care for immunocompromised patients at high risk acquiring infections.

Ambulatory Infection Prevention Risk Assessment: Not All Ambulatory Sites Are Created Equal

Healthcare is increasingly moving from acute care settings to ambulatory settings. In addition, many hospitals provide ambulatory care services at sites distant from where acute care is delivered. These sites may perform invasive procedures, high level disinfection (HLD)/sterilization, infusion services, care for immunocompromised patients and other activities with significant infection prevention risks. This poses a challenge for the infection preventionist (IP) who has to cover an ever growing number of off-site ambulatory services.

Microbiologic Contamination and Time Efficiency of Use of Automatic MDCT Injectors With Prefilled Syringes: Results of a Clinical Investigation

Multiple use of syringes in automatic injectors is considered to place patients at risk of septic complications. The purpose of this study was to evaluate the microbiologic contamination and time efficiency associated with routine clinical use of single-use prefilled disposable syringes for contrast administration. To ensure a hygienic background, imprints of devices and the palms of the hands of staff members were microbiologically analyzed before the clinical investigation. The microbiologic contamination of prefilled contrast and saline syringes was analyzed according to two protocols: single use of prefilled contrast syringes and saline syringes (n = 60) and single use of prefilled contrast syringes but multiple use of saline syringes for four injections or patients (n = 60). The time required for assembly of the injection system and filling and refilling for each protocol was measured. Contamination of the surfaces of devices and palms in the CT department was within the acceptable range for hygienic conditions. Prefilled disposable syringes for the contrast agent and saline solution used once had no microbiologic contamination. Microbial contamination with coagulase-negative staphylococci was found in two saline syringes used repeatedly. The time for assembly of the injection system and installation of prefilled syringes did not differ significantly (p = 0.45) between the single-use protocol (2.3 +/- 1.1 minutes) and the multiple-use protocol (2.0 +/- 1.4 minutes). Use of prefilled contrast syringes with single-use saline syringes is associated with time-efficient assembly of injection systems and prevents microbiologic contamination in clinical routine, especially in the care of immunocompromised patients.

Care of immunocompromised patients in hospital

Care of immunocompromised patients in hospital

Care of immunocompromised patients in hospital

Infection presents a significant risk for immunocompromised patients. To reduce this risk, various precautions can be implemented and these may affect patients' quality of life. Such precautions are controversial, with varying practices being adopted by different hospitals. This article aims to enhance nurses' knowledge about the current evidence on the interventions designed to reduce the rate of infection in immunocompromised patients who are in hospital.

Pulmonary Cryptococcosis After Initiation of Anti-Tumor Necrosis Factor-alpha Therap

INTRODUCTION: Pulmonologists often participate in the care of immunocompromised patients as the majority of infections in this population involve the lungs. The infectious complications associated with the use of traditional cytotoxic agents are well known. The immunosuppressive effect of targeted anti-cytokine therapy, however, is now being defined. Infliximab, a chimeric monoclonal antibody against Tumor Necrosis Factor-alpha (TNF-α), has revolutionized the care of patients with rheumatoid arthritis. Interestingly, the spectrum of infectious disease associated with the use of anti-TNF-α therapy is similar to patients with AIDS and include tuberculosis, histoplasmosis, and cryptococcosis. This suggests that anti-TNF-α therapy produces a downstream defect in the T helper-1 arm of immunity. We report a case of pulmonary cryptococcosis after the initiation of infliximab.

Prevention of infection in the immunocompromised host

The Association for Professionals in Infection Control and Epidemiology, Inc, is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center’s Commission on Accreditation. This learner-paced study package is designated for 1.1 contact hours. APIC’s California nursing provider number is CEP 7146. This continuing medical laboratory education activity is recognized by the American Society of Clinical Pathologists as meeting the criteria for 1 CMLE credit hour. ASCP CMLE credit hours are acceptable to meet the continuing education requirements for the ASCP Board of Registry Continuing Competence Recognition Program. (See the instructions and examination at the end of the article.) Infectious diseases represent a major cause of morbidity and mortality in immunocompromised patients. Infectious complications are often predictable and may be preventable. This article is an overview of practical considerations in the care of immunocompromised patients. Recognizing the compromised host, identifying and correcting risk factors in advance, and reducing sources of infection all play a role in prevention. Topics were chosen to include the areas of care that differ from the immune competent patient, such as diet, pet therapy, handwashing, immunizations, augmentation of host resistance, prevention of pneumonia, and antibiotic prophylaxis. National practice guidelines are cited when possible; evidence-based literature review and experience are applied to situations lacking consensus statements. Treatment decisions are made in areas for which information is often incomplete. A systematic approach to care of the immunocompromised host, tailored to the individual patient’s needs, should reduce the risk of infection. (AJIC Am J Infect Control 1998;26:594-606)

More than 10 years of unrecognized nosocomial transmission of legionnaires' disease among transplant patients.

To investigate a cluster of cases of legionnaires' disease among patients at a hospital. A university hospital that is a regional transplant center. Retrospective review of microbiology and serology data from the hospital laboratories and prospective surveillance via the radiology department; a case-control study and environmental sampling within the hospital and from nearby cooling towers. Diagnosis of seven cases of legionnaires' disease in the first 9 months of 1996 led to recognition of a nosocomial outbreak that may have begun as early as 1979. Review of charts from 1987 through September 1996 identified 25 culture-confirmed cases of nosocomial or possibly nosocomial legionnaires' disease, including 18 in bone marrow and heart transplant patients. Twelve patients (48%) died. During the first 9 months of 1996, the attack rate was 6% among cardiac and bone marrow transplant patients. For cases that occurred before 1996, intubation was associated with increased risk for disease. High-dose corticosteroid medication was strongly associated with the risk for disease, but other immunosuppressive therapy or cancer chemotherapy was not. Several species and serogroups of Legionella were isolated from numerous sites in the hospital's potable water system. Six of seven available clinical isolates were identical and were indistinguishable from environmental isolates by pulsed-field gel electrophoresis. Initial infection control measures failed to interrupt nosocomial acquisition of infection. After extensive modifications to the water system, closely monitored repeated hyperchlorinations, and reduction of patient exposures to aerosols, transmission was interrupted. No cases have been identified since September 1996. Legionella can colonize hospital potable water systems for long periods of time, resulting in an ongoing risk for patients, especially those who are immunocompromised. In this hospital, nosocomial transmission possibly occurred for more than 17 years and was interrupted in 1996, after a sudden increase in incidence led to its recognition. Hospitals specializing in the care of immunocompromised patients (eg, transplant centers) should prioritize surveillance for cases of legionnaires' disease. Aggressive control measures can interrupt transmission of this disease successfully.

Host defenses against respiratory infection

The respiratory tract is protected from infection by its formidable mechanical and cellular defenses, supplemented when necessary by inflammatory and immune responses. Impairments in these defenses develop as a result of underlying disease and therapeutic interventions. Specific defects in host defenses often predispose to infection with particular etiologic agents. New opportunities for the therapeutic augmentation of defenses are emerging that may be particularly helpful in the care of immunocompromised patients.

Cell-Mediated Immunity in Experimental Cytomegalovirus Infections: A Perspective

Treatment of cytomegalovirus (CMV) infections has assumed increasing importance in the care of immunocompromised patients, particularly allograft recipients and patients with symptomatic infection with the human immunodeficiency virus. The crucial role of T cells in the host defense against CMV may be inferred by the expression of life-threatening CMV disease in these restricted patient subpopulations. However, detailed understanding of the pathogenesis of CMV disease in the compromised host is lacking, and the mechanisms by which T cells confer protection are unknown. Insight into the pathogenesis of CMV in these patients is crucial for the development of rational therapeutic strategies. A considerable body of data has been generated to explore the role of T cell-mediated immunity in a number of model viral infections as well as in experimental CMV infections in both normal and immunocompromised mice. This experience will be critically reviewed to clarify the often conflicting observations regarding a protective or, conversely, a pathogenic role for T cells in producing CMV disease.

RADIATION STERILIZATION OF SPICES FOR HOSPITAL FOOD SERVICES AND PATIENT CARE

ABSTRACTA survey of the commercial spices used by food services in a typical hospital environment revealed high contamination with microorganisms, i.e., 104 to 107 counts per gram. The predominant microorganisms were as followed (in colony counts/gram): (1) heat‐resistant bacterial spores in black pepper, 1 × 107; thyme, 2 × 106; anise, 7 × 104; curry powder, 4 × 105; poultry seasoning, 8 × 104; pickling spice, cardamom, and cumin, 1.5–3 × 104; (2) mixed populations of vegetative cells and bacterial spores in cumin, 1 × 106; (3) molds in cream of tartar, 2 × 104. Sterility of food may be important in a hospital setting, especially in the care of immunocompromised patients. To eliminate the organisms, we recommend radiation treatment, accompanied by appropriate microbiological quality control. On the basis of radiation survival data, the composite natural flora would be reduced to the level of “commercial sterility” (defined as less than 10 organisms per gram((Kiss 1982) by the following minimum radiation doses (in kGy): black pepper, 13; thyme, 13; cumin, 12; anise, 10; curry, 7.3; pickling spice, 7; poultry seasoning, 6; cardamom, 9.4; cream of tartar, 4. For practical purposes, two dose levels can be recommended for treatment of spices in the hospital environment, low = 6–10 kGy and high = 10–15 kGy.

A Conceptual Approach to Immunodeficiency

Immunodeficiency represents a congenital or acquired aberration of immune function which is commonly associated with autoimmunity and neoplasia as a potential triad of biologic sequelae. Irrespective of the initial focal point in the triad, the natural evolution of the condition is frequently associated with the other two. This conceptualization should increase the clinician's ability in a more understanding approach to the evaluation and care of immunocompromised patients.