Infectious complications

Complications associated with PD include mechanical problems related to the PD catheter, metabolic problems associated with the components of the dialysate fluid, damage to the peritoneal membrane, and infections (Table 23-10). Strategies to manage infectious complications of PD are discussed below. 

I Human bites are third most common and the most serious.44 Before the availability of antibiotics, up to 20% resulted in amputation. Currently, human bite-associated amputation rates remain at 5%, secondary to vascular compromise and infectious complications.43... 

There are two types of human bite injuries. Occlusal injuries are inflicted by actual biting, whereas clenched-fist injuries are sustained when a person s closed fist hits another s teeth. Of the two, clenched-fist injuries typically are more prone to infectious complications.43,44... 

Thorough irrigation with normal saline is the first step in the care of an infected bite wound. The wound should be elevated and immobilized. Surgical closure may be advocated, especially for facial wounds. Wounds that are infected, at higher risk for infection, or older than 24 hours should be left open because premature closure can lead to disastrous infectious complications.43... 

CML arises from a defect in an early progenitor cell. Several cell lines may be affected, including myeloid, erythroid, megakaryocyte, and rarely, lymphoid lineages. These cells remain functional in chronic-phase CML, which is why patients in this phase are at low risk for developing infectious complications. 

The most commonly used dose for fludarabine is 20 mg/m2 intravenously daily for 5 consecutive days, whereas chlorambucil can be taken daily as an oral tablet with the dose ranging from 4 to 10 mg/day.21 Fludarabine is associated with more toxicities than chlorambucil, including myelosuppression and prolonged immunosuppression.19 Resulting infectious complications may occur during the periods of prolonged immunosuppression. The ease of administration and limited side effects make chlorambucil a practical option for symptomatic elderly patients who require palliative therapy... 

Campath) hypotension prolonged immunosuppression (resulting in infectious complications) during treatment. Premedicate with acetaminophen, diphenhydramine, with or without a steroid to alleviate infusion-related reactions. Subcutaneous dosing may lessen acute toxicity. Initially 3 mg/day as a 2-hour infusion, increase to 1 0 mg/day, then 30 mg/day as tolerated. 

Fludarabine (Fludara) Myelosuppression prolonged immunosuppression resulting in secondary infectious complications edema neurotoxicity Dose 20 mg/m2 IV daily for S days. 

Choose an appropriate regimen to minimize the risk of infectious complications in HCT patients. 

Recipients of HCT are at higher risk of bacterial, viral, and fungal infections and usually receive a prophylactic or preemptive regimen to minimize the morbidity and mortality owing to infectious complications. 

Febrile neutropenia is a common adverse effect of the administration of cytotoxic chemotherapy. The mortality rate owing to infectious complications currently remains between 5% and 10% therefore, febrile neutropenia is considered a true oncologic emergency. Patients frequently require hospitalization for prompt administration of broad-spectrum antibiotics that are critical to avoid morbidity and mortality. 

Parenteral nutrition can be a lifesaving therapy in patients with intestinal failure, but the oral or enteral route is preferred when providing nutrition support ( when the gut works, use it ). Compared with PN, enteral nutrition generally is associated with fewer infectious complications (e.g., pneumonia, intraabdominal abscess, and catheter-related infections) and potentially improved outcomes.1-3 However, if used in appropriate patients (i.e., patients with questionable intestinal function or when the intestine cannot be used), PN can be used safely and effectively and may improve nutrient delivery.4 Indications for PN are listed in Table 97-1.1... 

Patients receiving central PN are at increased risk of developing infectious complications caused by bacterial and fungal pathogens.1,50 Infections maybe related to placement of a central venous catheter, contamination of a central venous catheter or... 

Enteral nutrition (EN) is associated with fewer infectious complications than parenteral nutrition (PN). 

Infectious complications of EN include aspiration pneumonia and infections related to delivery of contaminated EN formula. Aspiration is a complication with GI, mechanical, and infectious implications. Although GI infections owing to contamination of enteral formulas have been reported uncommonly, there is ample opportunity for these formulas to be seeded with organisms during the processes of transferring from the can to the delivery bag with ready-to-use formulas and during the process of reconstitution with powdered formulas. The so-called closed systems of delivery, wherein the formulas come from the manufacturer premixed in a delivery bag, should help to decrease the chance of formula contamination. 

Develop a plan to include monitoring at appropriate intervals for metabolic, gastrointestinal, technical, and infectious complications. 

Nichols RL, Broido P, Condon RE, Gorbach SL, Nyhus LM Effect of preoperative neomycin-erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. Ann Surg 1973 178 453-462. 

Clinical presentations of the opportunistic infections are presented in Infectious Complications of HIV below. 

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