Sepsis —Immunocompromised Patients — Clinical Pathway: Emergency Department, Inpatient and PICU

Sepsis Clinical Pathway — Emergency Department, Inpatient and PICU

Immunocompromised Patients

Antimicrobials

Red Zone — Antibiotic Recommendations for Patients with Septic Shock or Sepsis-Associated Organ Dysfunction

Yellow Zone — Sepsis Watcher: Antibiotic Recommendations for Patients with Suspected Bacterial Infection without Organ Dysfunction

Antifungal Coverage

No clear guidelines for when to begin empiric antifungal therapy exist, but empiric caspofungin can be considered in the presence of known risk factors and severe illness.

  • Known risk factors include:
    • Broad-spectrum antibiotic exposure
    • Neutropenia
    • Central venous catheter
    • Steroid use
    • Poor skin integrity
    • TPN
    • Bone marrow transplantation
  • Please call infectious diseases to discuss

Antivirals

In the presence of confirmed viral source of infection, antiviral therapy should be discussed with both Infectious Disease consultant and the consulting team that primarily follows the patient (Oncology, Immunology, Solid Organ Transplant service, etc.).

Other Therapies to Support the Immune Response

Discuss use of G-CSF, GM-CSF11-3, or granulocyte infusion4 in leukopenic patients and IVIG therapy in patients with low IgG levels with the consulting team that follows the patient (Oncology, Immunology, Solid Organ Transplant service, etc.) with careful attention to the unique aspects of the patient in question. There is insufficient evidence to make broad recommendations for these therapies.

References for Immunocompromised Patients

  1. Liang. Pediatr Drugs 2003; 5:673-684
  2. Meisel, et al. Am J Respir Crit Care Med 2009; 180:640-648
  3. Stephens, et al. Crit Care Med 2008; 36:448-454
  4. Grigull, et al. Support Care Cancer 2006; 14:910-916