Preventing opportunistic infections after hematopoietic stem cell transplantation: the Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Society for Blood and Marrow Transplantation Practice Guidelines and beyond.
Preventing opportunistic infections after hematopoietic stem cell transplantation: the Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Society for Blood and Marrow Transplantation Practice Guidelines and beyond.
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DOI：
10.1182/asheducation-2001.1.392
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发表时间：
2001-01-01
期刊：
影响因子：
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通讯作者：
Sepkowitz, K A
中科院分区：
文献类型：
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作者：
Sullivan, K M;Dykewicz, C A;Sepkowitz, K A
本文综述了血液和骨髓移植后感染预防的循证指南。建议适用于所有清髓性移植，无论受体（成人或儿童），类型（同种异体或自体）或移植来源（外周血，骨髓或脐带血）。在第一节中，Dykewicz博士描述了用于对支持这些建议的已发表证据的强度和质量进行评级的方法，并详细介绍了参与制定和审查指南的20多个学术团体和联邦机构。在第二部分，Longworth博士提出了医院感染控制的建议。手卫生，房间通风，卫生保健工作者和访客的政策，详细沿着与具体的医院和社区获得性病原体的控制指南。在第三节中，Boeckh博士详细介绍了预防病毒性疾病的有效做法。对于巨细胞病毒（CMV）血清阴性的同种异体移植物，建议使用去白细胞的血液，而对于有CMV风险的个体，建议根据pp 65抗原血症或DNA检测结果给予更昔洛韦作为预防或先发制人的治疗。还提出了预防水痘带状疱疹病毒（VZV）、单纯疱疹病毒（HSV）和社区呼吸道病毒感染的指南。在第四节中，Baden和Rubin博士回顾了预防侵袭性真菌感染的方法。医院的设计和政策可以减少暴露于真菌孢子污染的空气中，400 mg/天的氟康唑预防可以减少侵袭性酵母菌感染。在第五节中，Sepkowitz博士详细介绍了减少或预防移植后细菌或原虫疾病的有效临床实践。在第六节中，沙利文博士回顾了疫苗可预防的感染以及干细胞移植受者、家庭成员和卫生保健工作者的主动和被动免疫接种指南。
This review presents evidence-based guidelines for the prevention of infection after blood and marrow transplantation. Recommendations apply to all myeloablative transplants regardless of recipient (adult or child), type (allogeneic or autologous) or source (peripheral blood, marrow or cord blood) of transplant. In Section I, Dr. Dykewicz describes the methods used to rate the strength and quality of published evidence supporting these recommendations and details the two dozen scholarly societies and federal agencies involved in the genesis and review of the guidelines. In Section II, Dr. Longworth presents recommendations for hospital infection control. Hand hygiene, room ventilation, health care worker and visitor policies are detailed along with guidelines for control of specific nosocomial and community-acquired pathogens. In Section III, Dr. Boeckh details effective practices to prevent viral diseases. Leukocyte-depleted blood is recommended for cytomegalovirus (CMV) seronegative allografts, while ganciclovir given as prophylaxis or preemptive therapy based on pp65 antigenemia or DNA assays is advised for individuals at risk for CMV. Guidelines for preventing varicella-zoster virus (VZV), herpes simplex virus (HSV) and community respiratory virus infections are also presented. In Section IV, Drs. Baden and Rubin review means to prevent invasive fungal infections. Hospital design and policy can reduce exposure to air contaminated with fungal spores and fluconazole prophylaxis at 400 mg/day reduces invasive yeast infection. In Section V, Dr. Sepkowitz details effective clinical practices to reduce or prevent bacterial or protozoal disease after transplantation. In Section VI, Dr. Sullivan reviews vaccine-preventable infections and guidelines for active and passive immunizations for stem cell transplant recipients, family members and health care workers.