Introduction

The history and management of an intensive care patient suffering from systemic infection or sepsis or a patient who is in danger of becoming septic is totally different from that of a patient who will receive, or has received, a transplant. A patient who is registered on the waiting list for heart and/or lung transplantation has been chronically ill for months and even years. Patients waiting for a heart have circulatory and respiratory problems, multiple organ dysfunction and often show signs of immune depression. Lung transplant patients, however, have a long history of cystic fibrosis with all its associated infections, or have suffered from chronic bronchitis, emphysema or idiopathic fibrosis. All such patients have been under intensive medical care and observation and their underlying disease known and heavily and specifically treated. All transplant patients have to undergo major surgery with a long period of anaesthesia and extended trauma; they often receive multiple blood transfusions from foreign donors. After surgery, the patient experiences aggressive and chronic immunosuppression. Azathioprine, cyclosporin, tacrolimus and steroids are given within the first 7 days and remain at relatively high doses for another month. A rejection episode, which occurs in more than 60% of all transplant patients, needs an immediate boost of immunosuppression. Under this antirejection treatment, patients are at a significant risk of developing opportunistic infections.