Special considerations in immunosuppressed patients

Many patients encountered in the intensive care unit (ICU) are immunosuppressed. Immunosuppression may be caused by an underlying disease (e.g. haematological disease), by treatment (drugs to prevent organ rejection), or as a side effect of chemotherapy.

The immune system is generally plays a successful role in maintaining the integrity of the individual. It is made up of integumental function, the innate immune response, and the adaptive immune response. Immune function is not static and can change over the period of illness in some patients. Immunosuppression in itself does not cause pathology, but leaves the patient prone to infection, which is the cause of morbidity and mortality in immunosuppressed patients. This highlights the importance of infection control, the most important aspect of which is prevention.

The most important intervention is the timely initiation of appropriate antimicrobial therapy. Sending adequate and appropriate samples to the microbiology laboratory is also important in the management of an infected immunosuppressed patient.

In organ recipients, the required immunosuppression increases the risk of infection and can also make the onset of symptoms insidious.