Time-dependent antibiotics require drug concentrations greater than the minimum inhibitory concentration (MIC) for a certain period between doses, which usually ranges from 40 to 50% of the inter-dose interval for their best action. Continuous infusions are preferred over extended infusions for beta-lactam antibiotics and are associated with clinical benefits like a decrease in hospital stay, cost of therapy and mortality. For vancomycin, continuous infusion is associated with reduced toxicity and cost of therapy but no mortality benefit.
The number of admissions of immunocompromised patients in the Indian intensive care units (ICUs) is growing. This is because of availability of better treatments for acquired immunodeficiency states, increasing incidence and detection of cancer, with more aggressive therapies aimed at cancer cure, and increased expectations of better ICU outcomes in the cancer patient.1,2
The indications of immunosuppression have expanded, contributing to an increased number of immunocompromised patients. There is a sharp rise in the number of solid organ transplants being performed in India contributing to the increased number of patients with immunosuppression getting admitted to the ICU in immediate postoperative and subsequent follow-up period. In the pediatric population, we can recognize the genetic predisposition of patients to congenital immunodeficiency states. All these patients have greater susceptibility to new infections or reactivation of latent infections.3 Therefore, it is the need of the hour to develop Indian guidelines for prescribing antimicrobial therapy in this population presenting to the ICU.
We feel that the outcomes are likely to be better if these immunocompromised patients with infectious diseases requiring ICU admission are preferably treated at a tertiary care center where all diagnostic facilities along with specialists in microbiology, immunology, infectious disease are likely to be available. We present guidelines in five separate sections: febrile neutropenic patients, patients who have undergone a solid organ transplant, patients with human immunodeficiency virus infections presenting to ICU, congenital asplenia or hyposplenia, and those with congenital primary immunodeficiency syndromes.