Antimicrobial Stewardship on Patients with Neutropenia: A Narrative Review Commissioned by Microorganisms

Abstract

The emergence of antibiotic resistance poses a global health threat. High-risk patients such as those with neutropenia are particularly vulnerable to opportunistic infections, sepsis, and multidrug-resistant infections, and clinical outcomes remain the primary concern. Antimicrobial stewardship (AMS) programs should mainly focus on optimizing antibiotic use, decreasing adverse effects, and improving patient outcomes. There is a limited number of published studies assessing the impact of AMS programs on patients with neutropenia, where early appropriate antibiotic choice can be the difference between life and death. This narrative review updates the current advances in strategies of AMS for bacterial infections among high-risk patients with neutropenia. Diagnosis, drug, dose, duration, and de-escalation (5D) are the core variables among AMS strategies. Altered volumes of distribution can make standard dose regimens inadequate, and developing skills towards a personalized approach represents a major advance in therapy. Intensivists should partner antibiotic stewardship programs to improve patient care. Assembling multidisciplinary teams with trained and dedicated professionals for AMS is a priority.

Antimicrobial De-Escalation in Critically Ill Patients

“…In fact, more than 60% of patients undergoing chemotherapy and hematopoietic stem cell transplantation develop febrile neutropenia, defined as body temperature ≥ 38 • C and absolute neutrophil count < 0.5 × 10 9 /L [35]. These patients are often colonized with MDR pathogens and are particularly susceptible to developing infections, so clinicians are often prompted to prescribe extended courses of broad-spectrum antimicrobial therapies, contributing to the spread of antimicrobial resistance [36]. Hence, ADE as a part of antimicrobial stewardship algorithms is increasingly considered a main intervention even in immunocompromised patients [33].…”