Sepsis associated with immunosuppressive medications: An evidence-based review Journal Article
| Authors: | Gea-Banacloche, J. C.; Opal, S. M.; Jorgensen, J.; Carcillo, J. A.; Sepkowitz, K. A.; Cordonnier, C. |
| Article Title: | Sepsis associated with immunosuppressive medications: An evidence-based review |
| Abstract: | Objective: In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for sepsis associated with immunosuppressive medications that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis. Design: The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. Methods: The modified Delphi methodology used for grading recommendations built on a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along five levels to create recommendation grades from A to E, with A being the highest grade. Pediatric considerations to contrast adult and pediatric management are in the article by Parker et al. on p. S591. Conclusion: Immunosuppressed patients, by definition, are susceptible to a wider spectrum of infectious agents than immunologically normal patients and, thus, require a broader spectrum antimicrobial regimen when they present with sepsis or septic shock. Special expertise managing immunosuppressed patient populations is needed to predict and establish the correct diagnosis and to choose appropriate empiric and specific agents and maximize the likelihood that patients will survive these microbial challenges. |
| Keywords: | survival rate; fludarabine; neutropenia; review; methotrexate; evidence based medicine; evidence-based medicine; unindexed drug; mucosa inflammation; combination chemotherapy; cyclophosphamide; risk assessment; pneumonia; intensive care; questionnaire; immune tolerance; antibodies, monoclonal; antiinfective agent; mycobacterium tuberculosis; anti-bacterial agents; disease severity; tumor necrosis factor-alpha; systematic review; etanercept; herpes virus; sepsis; consensus development; azathioprine; virus infection; linezolid; vancomycin; immunocompromised host; corticosteroid; immunosuppressive treatment; tacrolimus; mycophenolic acid 2 morpholinoethyl ester; quinoline derived antiinfective agent; bacterial infection; rapamycin; caspofungin; fluconazole; candidiasis; mycosis; cyclosporin; immunosuppressive agents; antifungal agents; cytomegalovirus; aspergillus; aspergillosis; infection sensitivity; alemtuzumab; legionella; immunosuppressive agent; cephalosporin; piperacillin plus tazobactam; drug indication; antiviral agents; quinolone; cefepime; gram positive bacterium; septic shock; pneumocystis; candida; ceftazidime; adrenal cortex hormones; daclizumab; carbapenem; infliximab; practice guidelines; gram negative bacterium; shock, septic; mycophenolic acid; cryptococcus; mould; basiliximab; mycobacterium avium; amphotericin; beta lactam; humans; human; priority journal; listeria; nocardia; strongyloides; consensus development conferences; hepatitis, viral, human; immunophilins |
| Journal Title: | Critical Care Medicine |
| Volume: | 32 |
| Issue: | 11 Suppl. |
| ISSN: | 0090-3493 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2004-11-01 |
| Start Page: | S578 |
| End Page: | S590 |
| Language: | English |
| DOI: | 10.1097/01.ccm.0000143020.27340.ff |
| PROVIDER: | scopus |
| PUBMED: | 15542967 |
| DOI/URL: | |
| Notes: | Crit. Care Med. -- Cited By (since 1996):23 -- Export Date: 16 June 2014 -- CODEN: CCMDC -- Source: Scopus |
