背景:大量患者现在正在接受免疫抑制疗法或化疗。此类患者存在发生机会性感染或潜伏感染重新激活的重大风险,与较高的相关发病率和死亡率。此质量改进项目的目的是确定5种不同专业在评估和减轻接受免疫抑制治疗的患者发生机会性感染或潜伏性感染的风险方面的有效性。
方法:这是一个单一的中心审核,对在诊所就诊的患者提供免疫抑制治疗的记录进行审查,以了解以下情况:筛查血源性病毒[BBV]感染的证据,水痘和麻疹免疫,潜伏性/活动性结核病或低丙种球蛋白血症,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准则进行审计的,或缺乏具体建议的跨专业共识指南。还分别分析了两个亚群:接受更有效免疫抑制的患者和黑人和少数民族[BME]患者。.
结果:对于符合纳入标准的204例患者,BBV,水痘/麻疹和潜伏性结核病筛查不一致,就像接种疫苗的建议一样,很少有领域符合专业或共识准则。在一个专业中,不到10%的患者接受了HIV检测。在BME患者中进行HIV筛查[60%],麻疹[0%]和水痘[40%]免疫力和潜伏性[30%]或活动性[20%]TB较低。只有38%的患者接受有效的免疫抑制接受肺孢子虫预防,4个专科中的3个为这一类的患者提供了不到15%的预防。
结论:对于大多数专科而言,降低免疫抑制疗法感染风险的指南依从性不一致或较差。需要新的方法来突出此类风险并协助适当的免疫抑制前筛查。
BACKGROUND: 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.
METHODS: 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,.
RESULTS: 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.
CONCLUSIONS: 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.