The principles of this rating system were developed by the IDSA and the U.S. For most recommendations, prevention strategies are rated by the strength of the recommendation and the quality of the evidence supporting the recommendation ( Table 1 These recommendations are intended for use by the recipients, their household and other close contacts, transplant and infectious diseases specialists, HCT center personnel, and public health professionals. Unless otherwise noted, the recommendations presented in this report address allogeneic and autologous and pediatric and adult HCT recipients. For patients with on-going GVHD or continued use of immunosuppressive therapy, it is recommended to consider the patient as immune deficient and still at risk for significant infectious complications. Conventionally, this is thought to occur at approximately 24 months following HCT in patients who are not receiving immunosuppressive therapy and do not have active graft-versus-host disease (GVHD). The definition of immune competence following transplant is loosely defined by the ability of the HCT recipient to receive live vaccine following recovery from transplant. ![]() Individual clinicians may follow practice patterns that, although deviating from these recommendations, are nevertheless effective and sound.įor the purposes of this report, HCT is defined as transplantation of any blood- or marrow-derived hematopoietic stem cells (HSCs), regardless of transplant type (ie, allogeneic or autologous) or cell source (ie, bone marrow, peripheral blood, or umbilical cord blood ). Although considerable effort has gone into ensuring that the guidelines have a global perspective based on the currently available medical evidence, adherence to a particular recommendation may be inconsistent with national or regional guidelines, the availability of specific procedures or medications, or local epidemiological conditions. In presenting these guidelines, the committee is not intending to dictate standards of practice. Despite-or perhaps because of-these changes, infections still occur with increased frequency or severity among HCT recipients as a patient population. Furthermore, as with any field of medicine, published studies continue to add to the evidence regarding supportive medical care. These changes include new antimicrobial agents, broader use of reduced-intensity conditioning (RIC), the increasing age of HCT recipients, and more frequent use of alternative donor stem cell sources such as haploidentical donors and umbilical cord blood. Significant changes in the field of HCT since the publication of the original guidelines necessitated this update. ![]() In updating these guidelines, the committee sought to summarize the currently available data and present them as concisely as possible in an evidence-based fashion. An international group of experts in infectious diseases, HCT, and public health worked together to compile this document with 4 goals in mind: (1) to summarize the current available data in the field, (2) to provide evidence-based recommendations regarding prevention of infectious complications among HCT patients, (3) to serve as a reference for health care providers worldwide who care for HCT recipients, and (4) to serve as a reference for HCT recipients and their nonmedical caregivers. This report, cosponsored by the Center for International Blood and Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), European Blood and Marrow Transplant Group (EBMT), American Society for Blood and Marrow Transplant (ASBMT), Canadian Blood and Marrow Transplant Group (CBMTG), Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Association of Medical Microbiology and Infectious Diseases (AMMI), the Center for Disease Control and Prevention (CDC), and the Health Resources and Services Administration, represents an update of the guidelines published in 2000 for preventing infections among hematopoietic cell transplantion (HCT) recipients.
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