[CITATION][C] Principles of antimicrobial therapy in the transplant patient

RH Rubin, FM Marty - Transplant Infectious Disease, 2004 - Wiley Online Library
RH Rubin, FM Marty
Transplant Infectious Disease, 2004Wiley Online Library
EĦ ective antimicrobial therapy in the transplant recipient is particularly challenging because
of the need for both a therapeutic and preventative strategy when dealing with the infection.
Beyond the classic epidemiologic and host-related factors that are commonly thought of
when facing a particular infected patient, the transplant recipient presents the following
additional dimensions that need to be considered for adequate management (1): 1.
Microbial load is a major determinant of the prognosis for a given infected patient. The …
EĦ ective antimicrobial therapy in the transplant recipient is particularly challenging because of the need for both a therapeutic and preventative strategy when dealing with the infection. Beyond the classic epidemiologic and host-related factors that are commonly thought of when facing a particular infected patient, the transplant recipient presents the following additional dimensions that need to be considered for adequate management (1):
1. Microbial load is a major determinant of the prognosis for a given infected patient. The impaired in£ ammatory response to microbial invasion that is engendered by immunosuppressive therapy commonly results in a subtle presentation because of attenuation of signs and symptoms. As a result, the infectious process is frequently far more advanced than might be expected, and the microbial load signi˘-cantly greater than that expected in a normal host. Therefore, the management of antimicrobials includes the need for more prolonged therapy with its attendant toxicities, a greater chance for emergence of drug resistance, and the need for diminishing immunosuppressive therapy. The prognosis, both in terms of the infection and preservation of allograft function, is in large part determined by the speed with which diagnosis is made and the appropriate antibiotic (s) started (1^ 3).
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