Factors associated with increased risk for infection
| . | Variable . | Risk factors . |
|---|---|---|
| Patient-related factors | Age/functional status | Older age (>65 y old), poor functional status (frail) |
| Medical history | Preexisting comorbidities: chronic lung/liver disease, uncontrolled diabetes, severe malnutrition, IV drug use, hematologic cancer or any cancer on active chemotherapy or radiation treatment, chronic kidney disease on dialysis, asplenia, HIV/AIDS, primary immunodeficiencies, history of infections while on immunosuppressive therapies | |
| Socioeconomic status | Travel, high-cost burden, poor family/caregiver support, cognitive impairment. | |
| Therapy- and disease-related factors | Regimen chosen | Combination immunosuppressive therapy, high-cost burden |
| Length of treatment | Long-term/maintenance immunosuppressive therapy to maintain response | |
| Drug safety and side effect profile | Poor drug tolerability, polypharmacy (caveat: drug-drug interaction), strong need for laboratory/clinical monitoring while on treatment (eg, oral CP and risk for myelosuppression) | |
| Time to treatment | Shorter time from diagnosis to therapy (eg, patients with high disease burden) precluding appropriate immunization administration and/or infectious disease screening | |
| Dose response | Higher doses needed to achieve disease response | |
| Long-term efficacy | Frequent relapses, refractory disease |
| . | Variable . | Risk factors . |
|---|---|---|
| Patient-related factors | Age/functional status | Older age (>65 y old), poor functional status (frail) |
| Medical history | Preexisting comorbidities: chronic lung/liver disease, uncontrolled diabetes, severe malnutrition, IV drug use, hematologic cancer or any cancer on active chemotherapy or radiation treatment, chronic kidney disease on dialysis, asplenia, HIV/AIDS, primary immunodeficiencies, history of infections while on immunosuppressive therapies | |
| Socioeconomic status | Travel, high-cost burden, poor family/caregiver support, cognitive impairment. | |
| Therapy- and disease-related factors | Regimen chosen | Combination immunosuppressive therapy, high-cost burden |
| Length of treatment | Long-term/maintenance immunosuppressive therapy to maintain response | |
| Drug safety and side effect profile | Poor drug tolerability, polypharmacy (caveat: drug-drug interaction), strong need for laboratory/clinical monitoring while on treatment (eg, oral CP and risk for myelosuppression) | |
| Time to treatment | Shorter time from diagnosis to therapy (eg, patients with high disease burden) precluding appropriate immunization administration and/or infectious disease screening | |
| Dose response | Higher doses needed to achieve disease response | |
| Long-term efficacy | Frequent relapses, refractory disease |
Data are from Portielje et al,2 Ekstrand et al,3 Bouwman et al,4 , Listing et al,5 and Fox et al.6