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Antimicrobial Stewardship in Patients with Hematological Malignancies: Key Considerations

  • Antimicrobial Stewardship (M Stevens, Section Editor)
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Abstract

Purpose of review

This review establishes current evidence supporting antimicrobial stewardship programs for malignant hematology and hematopoietic stem cell transplant patients. It describes best practices and identifies opportunities for research. It examines metrics relevant to the patient population, and new approaches to the management of high-risk febrile neutropenia.

Recent findings

There is an urgent need for antimicrobial stewardship programs to optimize antimicrobial use in malignant hematology and stem cell transplant patients. Audit and feedback is effective and safe. Febrile neutropenia is a key area to optimize antimicrobial use. Shortening duration of antimicrobial therapy in fever of unknown origin appears to be feasible. Routine antimicrobial prophylaxis has been reexamined. Locally developed guideline for high-risk febrile neutropenia is a major intervention. Antifungal stewardship and rapid diagnostic technologies reduce unnecessary antifungal use. Metrics for antimicrobial stewardship programs in malignant hematology and stem cell transplant are multifaceted.

Summary

Antimicrobial stewardship in the malignant hematology and stem cell transplant population is feasible, effective, and safe. Current gaps in knowledge include the optimal duration of antimicrobial use in fever of unknown origin, and the safety of targeted therapy despite neutropenia. The ideal human resources requirement is unclear. Cost-effectiveness of antimicrobial stewardship interventions remains to be determined.

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Authors and Affiliations

  1. Sinai Health System-University Health Network Antimicrobial Stewardship Program, University Health Network, Munk Building, Room PMB 8, 585 University Ave., Toronto, ON, M5G 2N2, Canada

    Miranda So BScPhm, PharmD

  2. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

    Miranda So BScPhm, PharmD

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So, M. Antimicrobial Stewardship in Patients with Hematological Malignancies: Key Considerations. Curr Treat Options Infect Dis 11, 161–176 (2019). https://doi.org/10.1007/s40506-019-00189-2

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