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Immunocompromised Patients. Infections, Diagnostics and Nosocomial Transmission

Stjärne Asplund, Anna LU (2018)
Abstract
The aim of the work presented in this thesis was to improve the management of infections in immunocompromised patients by studying aspects of diagnostics, epidemiology and nosocomial transmission.
Infection and rejection are common complications in lung-transplant patients, and early diagnosis and treatment are important for a positive outcome. In a study of lung-transplant patients it was found that heparin-binding protein, IL-1 and IL-8 in bronchoalveolar lavage fluid (BALF) could be useful biomarkers for the detection of pulmonary infection. These biomarkers also seemed to discriminate between infection and rejection.
Haematology patients with severely impaired immunity are at high risk of developing invasive fungal disease... (More)
The aim of the work presented in this thesis was to improve the management of infections in immunocompromised patients by studying aspects of diagnostics, epidemiology and nosocomial transmission.
Infection and rejection are common complications in lung-transplant patients, and early diagnosis and treatment are important for a positive outcome. In a study of lung-transplant patients it was found that heparin-binding protein, IL-1 and IL-8 in bronchoalveolar lavage fluid (BALF) could be useful biomarkers for the detection of pulmonary infection. These biomarkers also seemed to discriminate between infection and rejection.
Haematology patients with severely impaired immunity are at high risk of developing invasive fungal disease (IFD), and early diagnosis remains a challenge to clinicians. In a study of 135 severely immunosuppressed haematology patients it was found that both (1-3)- -D-Glucan (BG) and galactomannan showed high diagnostic performance for exclusion of disease, but poor performance in early detection of IFD when used as screening markers. BG was shown to be the most useful tool for the diagnosis of IFD later in the course of infection. For optimal diagnostic performance, the use of the BG test should include quantification of BG above the maximum limit of detection of the assay and graphical evaluation of the dynamic pattern of BG. The diagnostic usefulness of bis(methyl)gliotoxin and the D-arabinitol/L-arabinitol ratio in urine appeared to be questionable in this cohort. It was also found that elevated levels of triglycerides could be a source of false-positive BG findings. The study further highlights the importance of assessment by a qualified radiologist in the diagnosis of IFD.
Lung-transplant patients have a high risk of microbial colonisation of the lung, and lung infections. To evaluate positive microbial findings in BALF, and to implement appropriate prophylaxis and treatment of infections, it is important to know the microbial panorama. A study was carried out on all lung-transplant patients in Sweden over a two-year period, and BALF samples from 85% of the patients had microbiologic finding(s), but the frequency of multidrug-resistant bacteria was low. The microbiological agents found in BALF from patients with and without lung infection were similar, providing further evidence that microbial results should be evaluated together with clinical symptoms and macroscopic appearance and in the assessment of lung infection in lung-transplant patients.
The final study was carried out during a prolonged nosocomial outbreak of a metallo-β-lactamase-producing Pseudomonas aeruginosa strain, affecting immunosuppressed patients. This was found to be associated with hospital sink drains, and a method of decontamination using acetic acid was proposed.
(Less)
Abstract (Swedish)
The aim of the work presented in this thesis was to improve the management of
infections in immunocompromised patients by studying aspects of diagnostics,
epidemiology and nosocomial transmission. Infection and rejection are common
complications in lung-transplant patients, and early diagnosis and treatment are
important for a positive outcome. In a study of lung-transplant patients it was
found that heparin-binding protein, IL-1β and IL-8 in bronchoalveolar lavage fluid
(BALF) could be useful biomarkers for the detection of pulmonary infection.
These biomarkers also seemed to discriminate between infection and rejection.
Haematology patients with severely impaired immunity are at high risk of
developing... (More)
The aim of the work presented in this thesis was to improve the management of
infections in immunocompromised patients by studying aspects of diagnostics,
epidemiology and nosocomial transmission. Infection and rejection are common
complications in lung-transplant patients, and early diagnosis and treatment are
important for a positive outcome. In a study of lung-transplant patients it was
found that heparin-binding protein, IL-1β and IL-8 in bronchoalveolar lavage fluid
(BALF) could be useful biomarkers for the detection of pulmonary infection.
These biomarkers also seemed to discriminate between infection and rejection.
Haematology patients with severely impaired immunity are at high risk of
developing invasive fungal disease (IFD), and early diagnosis remains a challenge
to clinicians. In a study of 135 severely immunosuppressed haematology patients
it was found that both (1-3)-β-D-Glucan (BG) and galactomannan showed high
diagnostic performance for exclusion of disease, but poor performance in early
detection of IFD when used as screening markers. BG was shown to be the most
useful tool for the diagnosis of IFD later in the course of infection. For optimal
diagnostic performance, the use of the BG test should include quantification of BG
above the maximum limit of detection of the assay and graphical evaluation of the
dynamic pattern of BG. The diagnostic usefulness of bis(methyl)gliotoxin and the
D-arabinitol/L-arabinitol ratio in urine appeared to be questionable in this cohort.
It was also found that elevated levels of triglycerides could be a source of falsepositive
BG findings. The study further highlights the importance of assessment
by a qualified radiologist in the diagnosis of IFD.
Lung-transplant patients have a high risk of microbial colonisation of the lung, and
lung infections. To evaluate positive microbial findings in BALF, and to
implement appropriate prophylaxis and treatment of infections, it is important to
know the microbial panorama. A study was carried out on all lung-transplant
patients in Sweden over a two-year period, and BALF samples from 85% of the
patients had microbiologic finding(s), but the frequency of multidrug-resistant
bacteria was low. The microbiological agents found in BALF from patients with
lung infection were similar to those in samples showing colonisation, providing
further evidence that microbial results should be evaluated together with clinical
symptoms and macroscopic appearance and in the assessment of lung infection in
lung-transplant patients.
The final study was carried out during a prolonged nosocomial outbreak of a
metallo-β-lactamase-producing Pseudomonas aeruginosa strain, affecting
immunosuppressed patients. This was found to be associated with hospital sink
drains, and a method of decontamination using acetic acid was proposed. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • docent Eriksson, Britt Marie, University of Uppsala
organization
alternative title
Immunsupprimerade patienter : Infektioner, diagnostik och nosokomial transmission
publishing date
type
Thesis
publication status
published
subject
pages
87 pages
publisher
Lund University: Faculty of Medicine
defense location
GK-salen, BMC, Sölvegatan 19 i Lund
defense date
2018-04-13 13:00:00
ISBN
978-91-7619-594-9
language
English
LU publication?
yes
additional info
ISSN: 1652-8220 Lund University, Faculty of Medicine Doctoral Dissertation Series 2018:27
id
82708bc8-91d4-4eac-9ced-347c3eaa9e50
date added to LUP
2018-03-10 10:31:06
date last changed
2019-11-19 13:49:34
@phdthesis{82708bc8-91d4-4eac-9ced-347c3eaa9e50,
  abstract     = {The aim of the work presented in this thesis was to improve the management of infections in immunocompromised patients by studying aspects of diagnostics, epidemiology and nosocomial transmission. <br/>Infection and rejection are common complications in lung-transplant patients, and early diagnosis and treatment are important for a positive outcome. In a study of lung-transplant patients it was found that heparin-binding protein, IL-1  and IL-8 in bronchoalveolar lavage fluid (BALF) could be useful biomarkers for the detection of pulmonary infection. These biomarkers also seemed to discriminate between infection and rejection.<br/>Haematology patients with severely impaired immunity are at high risk of developing invasive fungal disease (IFD), and early diagnosis remains a challenge to clinicians. In a study of 135 severely immunosuppressed haematology patients it was found that both (1-3)- -D-Glucan (BG) and galactomannan showed high diagnostic performance for exclusion of disease, but poor performance in early detection of IFD when used as screening markers. BG was shown to be the most useful tool for the diagnosis of IFD later in the course of infection. For optimal diagnostic performance, the use of the BG test should include quantification of BG above the maximum limit of detection of the assay and graphical evaluation of the dynamic pattern of BG. The diagnostic usefulness of bis(methyl)gliotoxin and the D-arabinitol/L-arabinitol ratio in urine appeared to be questionable in this cohort. It was also found that elevated levels of triglycerides could be a source of false-positive BG findings. The study further highlights the importance of assessment by a qualified radiologist in the diagnosis of IFD. <br/>Lung-transplant patients have a high risk of microbial colonisation of the lung, and lung infections. To evaluate positive microbial findings in BALF, and to implement appropriate prophylaxis and treatment of infections, it is important to know the microbial panorama. A study was carried out on all lung-transplant patients in Sweden over a two-year period, and BALF samples from 85% of the patients had microbiologic finding(s), but the frequency of multidrug-resistant bacteria was low. The microbiological agents found in BALF from patients with and without lung infection were similar, providing further evidence that microbial results should be evaluated together with clinical symptoms and macroscopic appearance and in the assessment of lung infection in lung-transplant patients. <br/>The final study was carried out during a prolonged nosocomial outbreak of a metallo-β-lactamase-producing Pseudomonas aeruginosa strain, affecting immunosuppressed patients. This was found to be associated with hospital sink drains, and a method of decontamination using acetic acid was proposed. <br/>},
  author       = {Stjärne Asplund, Anna},
  isbn         = {978-91-7619-594-9},
  language     = {eng},
  publisher    = {Lund University: Faculty of Medicine},
  school       = {Lund University},
  title        = {Immunocompromised Patients. Infections, Diagnostics and Nosocomial Transmission},
  url          = {https://lup.lub.lu.se/search/files/40168538/E_spik_Anna.pdf},
  year         = {2018},
}