Challenges and Opportunities in Antimicrobial Stewardship among Hematopoietic Stem Cell Transplant and Oncology Patients

Abstract

Antimicrobial stewardship programs play a critical role in optimizing the use of antimicrobials against pathogens in the era of growing multi-drug resistance. However, implementation of antimicrobial stewardship programs among the hematopoietic stem cell transplant and oncology populations has posed challenges due to multiple risk factors in the host populations and the infections that affect them. The consideration of underlying immunosuppression and a higher risk for poor outcomes have shaped therapeutic decisions for these patients. In this multidisciplinary perspective piece, we provide a summary of the current landscape of antimicrobial stewardship, unique challenges, and opportunities for unmet needs in these patient populations.

Review of advanced practice nurse role in infection throughout the hematopoietic stem cell transplant journey

“…Antimicrobial use in the HSCT patient population is distinctly challenging due to the complex nature of the patient cohort requiring potentially prolonged courses of antimicrobials and prophylaxis, therefore a thorough understanding of these principles is imperative when prescribing these medications to this complex patient group. 24 In addition to medication prescribing privileges, NPs have an expanded scope of practice expanding above the registered nurse scope of practice, which allows ordering and interpretation of diagnostic pathology and initiation of specialist referrals. These skills are transferrable to consultative nurse led clinics which focus on infection prevention throughout the HSCT treatment trajectory.…”

Implementing an Antimicrobial Stewardship Program in an Oncology Center in Lima, Peru: A Model for Low- and Middle-Income Countries

“…The performance and effects of AMS programs in low- and middle-income countries (LMICs) have not been extensively studied [ 1 ], and few studies have focused on patients with cancer [ 2–4 ]. In response to the urgent global need to combat antimicrobial misuse [ 5 , 6 ] and the worldwide rise in antimicrobial resistance, particularly in LMICs [ 7 ], we implemented an ambitious AMS program. However, we faced unique challenges: 1 significant challenge was that most of our medical staff worked part-time in the public sector, where they had adopted antimicrobial prescription practices that deviated from the regimens recommended in our center according to our microbiological profile.…”