Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, TS4 3BW, UK.
Undergraduate Department, James Cook University Hospital, Middlesbrough, UK.
BMC Infect Dis. 2020 May 20;20(1):359. doi: 10.1186/s12879-020-05082-8.
Substantial numbers of patients are now receiving either immunosuppressive therapies or chemotherapy. There are significant risks in such patients of developing opportunistic infections or re-activation of latent infections, with higher associated morbidity and mortality. The aim of this quality improvement project was to determine how effective 5 different specialties were in assessing and mitigating risks of developing opportunistic infections or re-activation of latent infections in patients undergoing immunosuppressive therapies.
This was a single centre audit where records of patients attending clinics providing immunosuppressive therapies were reviewed for the following: evidence of screening for blood-borne virus [BBV] infections, varicella and measles immunity, latent/active TB or hypogammaglobulinaemia, and whether appropriate vaccines had been advised or various infection risks discussed. These assessments were audited against both national and international guidelines, or a cross-specialty consensus guideline where specific recommendations were lacking. Two sub-populations were also analysed separately: patients receiving more potent immunosuppression and black and minority ethnic [BME] patients,.
For the 204 patients fulfilling the inclusion criteria, BBV, varicella/measles and latent TB screening was inconsistent, as was advice for vaccinations, with few areas complying with specialty or consensus guidelines. Less than 10% of patients in one specialty were tested for HIV. In BME patients screening for HIV [60%], measles [0%] and varicella [40%] immunity and latent [30%] or active [20%] TB was low. Only 38% of patients receiving potent immunosuppression received Pneumocystis prophylaxis, with 3 of 4 specialties providing less than 15% of patients in this category with prophylaxis.
Compliance with guidelines to mitigate risks of infection from immunosuppressive therapies was either inconsistent or poor for most specialties. New approaches to highlight such risks and assist appropriate pre-immunosuppression screening are needed.
现在大量患者正在接受免疫抑制治疗或化疗。这些患者有发生机会性感染或潜伏感染再激活的重大风险，相关发病率和死亡率更高。本质量改进项目的目的是确定 5 种不同专业在评估和降低接受免疫抑制治疗的患者发生机会性感染或潜伏感染再激活的风险方面的效果如何。
这是一项单中心审计，对提供免疫抑制治疗的诊所的患者记录进行了以下方面的审查：是否有血液传播病毒（BBV）感染、水痘和麻疹免疫力、潜伏/活动性结核病或低丙种球蛋白血症的筛查证据，以及是否建议了适当的疫苗或讨论了各种感染风险。这些评估是根据国家和国际指南进行的，或者在缺乏具体建议的情况下，根据跨专业共识指南进行的。还分别分析了两个亚人群：接受更强烈免疫抑制治疗的患者和少数族裔（BME）患者。
对于符合纳入标准的 204 名患者，BBV、水痘/麻疹和潜伏性结核病筛查不一致，疫苗接种建议也不一致，很少有领域符合专业或共识指南。在一个专业中，不到 10%的患者接受了 HIV 检测。在 BME 患者中，HIV [60%]、麻疹[0%]和水痘[40%]免疫力以及潜伏[30%]或活动性[20%]结核病的筛查率较低。只有 38%接受强效免疫抑制治疗的患者接受了预防卡氏肺孢子虫肺炎的治疗，其中 4 个专业中有 3 个为该类别中不到 15%的患者提供了预防治疗。
大多数专业在减轻免疫抑制治疗相关感染风险的指南方面要么不一致，要么执行不力。需要新的方法来突出这些风险，并协助进行适当的免疫抑制前筛查。
