Infections in nonleukopenic compromised hosts (diabetes mellitus, SLE, steroids, and asplenia) in critical care

Patients with diabetes mellitus, systemic lupus erythematosus, asplenia, and those on chronic high-dose steroid therapy, all have different varieties of impaired host defenses. Because of their impaired immunity, such patients are predisposed to develop serious and frequently life-threatening infections. Accordingly, such patients should be viewed as nonleukopenic compromised hosts. Infections in these individuals depend on the nature of the host defense defect associated with each of these disorders. Most infections in these patients are not unique, but are more severe and difficult to treat than the same infections occurring in normal individuals. The clinician should regard these patients as immunocompromised, but should differentiate them from leukopenic compromised hosts in terms of infecting organisms and their pattern of organ involvement. Early empiric therapy is essential and may be lifesaving.