[Antibiotic therapy in patients with immunologic deficiency]

Basic aspects in the treatment of immunocompromised patients are discussed with respect to medical and paediatric oncology, surgical intensive care and clinical pathology. Defining the type of immunological deficiency seems of primary importance, since it can be caused by haematological diseases, their treatment, by repeated surgery or by a polytrauma. The degree of immune deficiency should be quantitated by laboratory procedures, whenever possible. The treatment of these patients may include substitution therapy, decontamination and antimicrobial chemotherapy. Since the immune deficiency can only rarely be specifically substituted, hygiene plans should be made up for every patient, including the selective decontamination. An intensive microbiological surveillance can give early information about the prevalence of certain microorganisms, thereby facilitating a subsequent treatment. The antimicrobial chemotherapy of an overt infection in medical and pediatric oncology can follow fixed schedules, taking into account the various causative agents that can be expected. This procedure has proven to be efficient in the treatment of infections occurring during the therapy of acute lymphoblastoid leukemia in childhood. In surgical intensive care units, however, treatment of infections should be based on microbiological findings in conjunction with the local profile of bacterial resistance. Furthermore, it is important to be aware that "non-pathogenic" microorganisms can be the cause of life-threatening infections in immunocompromised patients. Our experience shows that interdisciplinary cooperation and a mutual exchange of information is important for an efficient treatment of infections in patients with immunological deficiencies.