Inactivated polio vaccine is recommended following allo and auto transplant (BII).21,36 More information is needed regarding optimal schedules of vaccination. Fungal infection in this patient population is difficult to diagnose and treat, and, not surprisingly, is associated with a prohibitively high mortality. Kulkarni S, Powles R, Treleaven J, et al. The 23-valent PPV had been recommended at 12 and 24 months after HSCT along with chemoprophylaxis in individuals with chronic GVHD (BIII).34 Recently, a 7-valent conjugate vaccine has been licensed.
The goals of the guidelines were to 1) summarize current data regarding the risk of OIs in HSCT recipients; 2) produce an evidence-based statement of recommended strategies for the prevention of OIs; and 3) decrease the prevalence, morbidity, and mortality of OIs in HSCT recipients. HSCT centers should follow published guidelines for preventing intravascular device-related infections (AIII).19, Legionellosis should be considered in the differential diagnosis of pneumonia in HSCT recipients (AIII).
Intravascular devices infected or colonized with MRSA should be removed (AIII). Rubin RH. Pneumonia (PJP) may develop via airborne transmission or reactivation of prior infection. Immunization of health care workers: recommendation of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee. Detection and identification of fungal pathogens in blood by using molecular probes.
Trimethoprim-sulfamethoxazole is the preferred prophylactic agent (AII). Guidelines for prevention of nosocomial pneumonia. Derouin F, Devergie A, Auber P, et al. HSV seronegative recipients should be informed about the mode of transmission of HSV and be advised of behavior that will decrease the likelihood of exposure, e.g.
RR-10):1–66, or. ‘number needed to treat’) of the intervention.
Larson EL. Extrinsic risk factors for pneumonia in the patient at high risk of infection. Brandt L, Broadbent V. A survey of recommendations given to patients going home after bone marrow transplant. Vaccination against infectious disease following hematopoietic stem cell transplantation. Antifungal therapy with an amphotericin preparation or one of the newer drugs (see below) is indicated in this circumstance.1,40, Detection of fungal antigens (e.g., Aspergillus galactomannan) or fungal metabolites (e.g., arabinitol) could give early evidence of invasive infection at a time when therapy would be most effective. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care facilities, 1994. A “I” rating means there is supporting evidence from at least one properly randomized, controlled trial. Efficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation—a prospective, randomized, double-blind study.
Laura R, Degl'Innocenti M, Moscali M, et al.
Foot AB, Garin YJ, Ribaud P, Devergie A, Derouin F, Gluckman E. Prophylaxis of toxoplasmosis infection with pyrimethamine/sulfadoxine (Fansidar) in bone marrow transplant recipients. Ochs L, Shu XO, Miller J, et al.
In pediatric areas, a nontoxic disinfectant should be used (BIII).
Can be administered to HSCT recipients with severe hypogammaglobulinemia (immunoglobulin G < 400 mg/dl) ≈ 100 days after HSCT to prevent bacterial infections. The CDC, the IDSA, and the ASBMT have recently published guidelines for preventing opportunistic infections among HSCT recipients. Copyright ©2020 by American Society of Hematology, https://doi.org/10.1182/asheducation-2001.1.392, www.cdc.gov/mmwr/preview/mmwrhtml/rr4910a1.htm, http://books.nap.edu/books/0309047412/html/index.html, http://www.cdc.gov/ncidod/publications/eid_plan/home.htm, http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00038328.htm, http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00048226.htm, http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr4810a1.htm, http://www.cdc.gov/ncidod/hip/sterile/sterilgp.htm. Herbrecht R, Denning D.W. , Patterson, T.F., et al. RR-12):1–46, or, Centers for Disease Control and Prevention.
upper respiratory tract infections, flu-like illnesses, recent exposure to communicable diseases, an active shingles rash whether covered or not, a VZV-like rash within 6 weeks of receiving a live attenuated varicella vaccine, or a history of receiving an oral polio vaccine within the previous 3-6 weeks) should not be allowed in the HSCT center or have direct contact with HSCT recipients or candidates undergoing conditioning therapy.
Peggs KS, Preiser W, Kottaridis PD, et al.
When possible, HSCT recipients should avoid contact with persons with PCP (CIII).
Hospital Infection Control Practices Advisory Committee.
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