Antimicrobial Prophylaxis in Oncological Hematology
Summary
Antimicrobial prophylaxis is a cornerstone in the management of patients with haematological malignancies, especially those undergoing intensive chemotherapy or haematopoietic stem cell transplantation. The profound neutropenia induced by cytotoxic regimens renders patients highly susceptible to bacterial and fungal infections, with febrile episodes and bloodstream infections accounting for significant morbidity, prolonged hospital stay and mortality. Prophylactic strategies typically employ fluoroquinolones, trimethoprim–sulfamethoxazole or cephalosporins to reduce the incidence of bacteremia and associated complications. While these approaches demonstrably lower infection rates, they also risk selection of resistant organisms, shifts in microbial ecology and impacts on hospital antibiotic stewardship. Current guidelines recommend tailoring prophylaxis to individual patient risk, local resistance patterns and treatment phase, balancing efficacy, safety and ecological consequences. Cost considerations and quality-of-life implications further inform decisions, highlighting the need for dynamic, evidence-based protocols in diverse healthcare settings.
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Antimicrobial Prophylaxis in Oncological Hematology publication trend
The graph below shows the total number of articles in antimicrobial prophylaxis in oncological hematology across all publications each year (not limited to Nature Index journals).
Technical terms
Neutropenia: A marked decrease in circulating neutrophils that impairs innate immune defence and predisposes to severe infections.
Fluoroquinolone prophylaxis: Preventive administration of broad-spectrum antibiotics, such as ciprofloxacin or levofloxacin, to reduce bacterial infections during periods of immunosuppression.
Bacteraemia: The presence of viable bacteria in the bloodstream, often leading to systemic inflammatory response and sepsis.
Haematopoietic stem cell transplantation (HSCT): A therapeutic procedure replacing diseased bone marrow with healthy progenitor cells, associated with prolonged immunosuppression.
Extended-spectrum beta-lactamases (ESBL): Enzymes produced by certain bacteria that confer resistance to penicillins and cephalosporins, complicating prophylaxis and treatment.
References
- Cost-Effectiveness of Targeted Prophylaxis among Allogenic Stem Cell Transplant Recipients. Pharmaceuticals (2023).
- Efficacy of antibiotic prophylaxis in patients with cancer and hematopoietic stem cell transplantation recipients: A systematic review of randomized trials. Cancer Medicine (2019).
- Efficacy of levofloxacin as an antibacterial prophylaxis for acute leukemia patients receiving intensive chemotherapy: a systematic review and meta-analysis. Hematology (2019).
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