Sepsis associated with immunosuppressive medications: an evidence-based review

Crit Care Med. 2004 Nov;32(11 Suppl):S578-90. doi: 10.1097/01.ccm.0000143020.27340.ff.


Objective: In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for sepsis associated with immunosuppressive medications that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis.

Design: The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee.

Methods: The modified Delphi methodology used for grading recommendations built on a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along five levels to create recommendation grades from A to E, with A being the highest grade. Pediatric considerations to contrast adult and pediatric management are in the article by Parker et al. on p. S591.

Conclusion: Immunosuppressed patients, by definition, are susceptible to a wider spectrum of infectious agents than immunologically normal patients and, thus, require a broader spectrum antimicrobial regimen when they present with sepsis or septic shock. Special expertise managing immunosuppressed patient populations is needed to predict and establish the correct diagnosis and to choose appropriate empiric and specific agents and maximize the likelihood that patients will survive these microbial challenges.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adrenal Cortex Hormones / adverse effects
  • Anti-Bacterial Agents / therapeutic use
  • Antibodies, Monoclonal / adverse effects
  • Antifungal Agents / therapeutic use
  • Antiviral Agents / therapeutic use
  • Aspergillosis / drug therapy
  • Candidiasis / drug therapy
  • Consensus Development Conferences as Topic
  • Evidence-Based Medicine
  • Hepatitis, Viral, Human / drug therapy
  • Humans
  • Immune Tolerance / immunology
  • Immunocompromised Host
  • Immunophilins / metabolism
  • Immunosuppressive Agents / adverse effects*
  • Mycophenolic Acid / adverse effects
  • Pneumonia / drug therapy
  • Practice Guidelines as Topic
  • Sepsis / drug therapy
  • Sepsis / etiology*
  • Sepsis / immunology
  • Shock, Septic / etiology
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors


  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Antibodies, Monoclonal
  • Antifungal Agents
  • Antiviral Agents
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha
  • Immunophilins
  • Mycophenolic Acid