Antimicrobial Resistance in Hematological Oncology

Antimicrobial resistance poses a critical challenge in the management of patients with haematological malignancies. Intensive chemotherapy, stem cell transplantation and prolonged neutropenia compromise host defences, creating an environment in which bacterial pathogens exploit weakened immune barriers. The predominance of Gram-negative organisms, increasingly harbouring extended-spectrum beta-lactamases and carbapenemases, has shifted empirical therapy towards broader spectrum agents, often at the expense of collateral damage and further resistance selection. Gram-positive pathogens, including coagulase-negative staphylococci and vancomycin-resistant enterococci, also contribute to morbidity, particularly in central venous catheter-associated infections. Recent efforts have centred on rapid diagnostic platforms, antimicrobial stewardship interventions and predictive risk models to refine empiric choices and reduce exposure to ineffective or unnecessarily broad regimens. Despite these advances, mortality from multidrug-resistant bloodstream infections remains unacceptably high. A concerted approach encompassing global surveillance, optimisation of prophylactic strategies and development of novel antimicrobials is essential to mitigate the impact of resistance in this vulnerable population.

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Antimicrobial Resistance in Hematological Oncology publication trend

The graph below shows the total number of articles in antimicrobial resistance in hematological oncology across all publications each year (not limited to Nature Index journals).

Technical terms

Bloodstream infection (BSI): The presence of pathogenic microorganisms in the blood circulation, often leading to systemic inflammatory response in immunocompromised hosts.

Multidrug‐resistant (MDR): Refers to bacteria resistant to three or more antimicrobial classes, limiting treatment options.

Extended‐spectrum beta‐lactamase (ESBL): Enzymes produced by certain Gram-negative bacteria that hydrolyse penicillins and cephalosporins, conferring high-level resistance.

Carbapenemase: A subclass of beta-lactamase enzymes capable of degrading carbapenem antibiotics, often marking pan-resistance.

Empirical therapy: Initiation of antimicrobial treatment based on clinical judgement and epidemiology prior to definitive pathogen identification.

References

1. Microbiology and prognostic prediction model of bloodstream infection in patients with hematological malignancies. Frontiers in Cellular and Infection Microbiology (2023).
2. Impact of Adding a Rapid PCR-Based Blood Culture Identification Panel to the Antimicrobial Stewardship Program of Patients with Febrile Neutropenia in a Peruvian Referral Hospital. Antibiotics (2023).
3. Bloodstream infections due to Gram-negative bacteria in patients with hematologic malignancies: updated epidemiology and risk factors for multidrug-resistant strains in an Italian perspective survey. International Journal of Antimicrobial Agents (2023).