Infection prevention in transplant patients

Worth LJ1,2,3

1Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Doherty Institute, VIC, 3000; 2Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, VIC, 3181; 3Peter MacCallum Cancer Centre, VIC, 3000

E: Leon.worth@mh.org.au

 

Background: With an increasing number of solid organ and stem cell transplants now performed in Australia, and improved long-term survival, there is an expanding population at risk for infection. These patients traverse inpatient, outpatient and ambulatory care contexts, and may be co-managed by smaller healthcare facilities following transplantation. This presentation will review the burden of infections in transplant populations, the scope of existing guidelines for infection prevention, and highlight challenges to infection prevention services posed by emerging threats.

 

Methods: Previously published recommendations for management of haematopoietic stem cell transplant and sold organ transplant recipients are reviewed, including consensus guidelines endorsed by the European Group for Blood and Marrow Transplantation, Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Society for Blood and Marrow Transplantation.

 

Results: Review of practices internationally demonstrates heterogeneity in infection prevention practices in transplant recipients, despite availability of recommendations for environmental cleaning, isolation/cohorting and surveillance in high-risk populations. Strategies with potential for maximal organisational impact will be highlighted: post-transplant vaccination, screening and isolation of patients with multi-resistant organisms. New and emerging infections (CPE, viral respiratory infections, Pneumocystis jirovecii) pose specific threats to immunocompromised patients.

 

Conclusions: International consensus guidelines for management of stem cell transplant recipients and infection-specific guidelines are available for solid organ transplant recipients. However, relevance, uptake and implementation in Australia is unknown. Guidelines for structuring of infection prevention programs for Australian transplant wards/units would standardised care.

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