By Robert H. Rubin
"Infection within the Compromised Host" has turn into a vintage bankruptcy in textbooks dedicated to infectious illnesses and inner drugs. The numbers of compromised hosts are expanding within the period of modem drugs due to our increased functions to house tough illnesses, specially neoplasms. for that reason, microbiologic problems with regards to the extensive care administered to those sufferers are expanding in addition. below those circum stances, not just does the underlying disorder create stipulations favorable for the improvement of surprising infections, yet frequently the treatment contributes to the purchase of power pathogens that become brokers chargeable for serious and regularly deadly ailment. Granulocytopenia and immunosuppression were the 2 key fac tors in predisposing sufferers with melanoma and different critical illnesses to critical bacterial infections. Colonization by way of hospital-acquired pathogens and breaks within the anatomic barriers-as because of the sickness or clinical intervention-have contributed to the excessive occurrence of infectious ailments in those sufferers. even though there's a few overlap among the kinds of an infection in granulocytopenic and immunosuppressed hosts, each one ofthese medical entities has specified good points thatjustify contemplating them individually, booking the time period immunocompromised hosts merely while refer ring to sufferers who're predisposed to opportunistic infections. for roughly 20 years, infections in granulocytopenic sufferers have attracted the atten tion of clinicians simply because they symbolize a version for the examine of antimicrobial medications in hosts disadvantaged of an important section of security opposed to bacterial an infection, that's, an sufficient variety of mostly functioning granulocytes.
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Extra resources for Clinical Approach to Infection in the Compromised Host
They showed that the bacterial counts of mop water from hospital floors where burned patients had been hospitalized decreased from 12 x 105 cfu/ml at 5 days after discharge to none by week 8. 7 x 106 cfu/cm 3 of P. aeruginosa. Crevices and corners of the floor not easily cleansed by standard mopping may provide a nidus where microorganisms survive for long periods. The skin of the hands has been known to be a source of microorganisms since Semmelweis (18181865) first attributed the spread of puerperal fever to the contaminated hands of attending physicians.
The quality of air relative to its microbial content is directly related to the air-handling system and the effectiveness of the housekeeping cleaning procedures. Positive air pressure should be maintained in alI patients' rooms to prevent air-bome bacteria and spores from entering the rooms from more highly contaminated hallways. Air-conditioning filters should be changed or decontaminated on a regularly scheduled basis whether central or room air conditioners are used. Housekeeping equipment that tends to redisperse microorganisms into the air, such as brooms and brushes, are to be avoided, and wet versus damp-mopping procedures using a double-bucket system to kill and remove microorganisms that have settled to the floor should be employed.
The reason for these disparities is not entirely clear; our own belief is that these agents are effective in substantialIy reduc ing the infection rate ifliquid preparations are used, if the patient ingests them regularly, and if the patient is at maximum risk of infection because of granulocyte counts ofless than 100//-LI that persist for at least 1014 days. The liquid preparation is useful because it helps to suppress the oral flora and hence should reduce pharyngitis, esophagitis, and pneumonitis.