Improvements in the prevention and management of infectious complications after hematopoietic stem cell transplantation

Abstract

Management of infections in HSCT recipients as reviewed in this chapterillustrates the dynamic nature of the challenges that patients and their health care team will face as long as transplantation is associated with periods of profound immune dysfunction. The past decade has seen a significant increase in overall survival of HSCT recipients. Two of the major factors responsible for this improved outcome have been early diagnosis and preemptive therapy of CMV infection and the ability to prevent some fungal pathogens with fluconazole prophylaxis. Despite these significant successes, natural selection keeps providing the transplant team and HSCT recipient new infectious disease challenges. Transplant approaches must be developed that can provide improved primary disease control and at the same time preserve immune function. Until that time comes, transplant teams must remain vigilant about infection risks, implement all reasonable prevention measures, and remain aware of both the commonly recognized infectious pathogens and the new pathogens or antimicrobial-resistant organisms that may evolve as a consequence of the use of antimicrobial agents. We would like to emphasize the importance of basic infectious principles that have been lumped in the past under the umbrella of "standard infection control measures." These include but are not limited to hand washing, providing clean air and water to our patients, and isolation of patients known to be colonized with pathogens that are unusually virulent, resistant to antimicrobial therapy, and/or easily spread among patients and health care workers. Basic infection control practices coupled with advancing measures for infection prevention and early infection diagnosis and management are likely to provide not only the best transplant outcomes but also the highest health care value. These time-honored aspects of care for the HSCT recipient will likely never go out of style, but at the same time, frame the challenge summarized by the statement, "Where there is immune dysfunction there will continue to be increased risk of infectious complications that will need to be addressed".