The role of antibiotic stewardship in limiting antibacterial resistance among hematology patients

Gyssens, Inge C.; Kern, Winfried V.; Livermore, David M.

doi:10.3324/haematol.2013.091769

Cited by 93 publications

(57 citation statements)

References 31 publications

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“…To reach this goal, antimicrobial stewardship in the hematology ward is crucial, and yet more difficult than with other patient populations. 323 This requires studies and resources. 3.…”

Section: The Eha Roadmap For European Hematology Researchmentioning

confidence: 99%

The European Hematology Association Roadmap for European Hematology Research: a consensus document

et al. 2016

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T he European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness of the burden of blood disorders on European society, which purely in economic terms is estimated at €23 billion per year, a level of cost that is not matched in current European hematology research funding. In recent decades, hematology research has improved our fundamental understanding of the biology of blood disorders, and has improved diagnostics and treatments, sometimes in revolutionary ways. This progress highlights the potential of focused basic research programs such as this EHA Roadmap. The EHA Roadmap identifies nine 'sections' in hematology: normal hematopoiesis, malignant lymphoid and myeloid diseases, anemias and related diseases, platelet disorders, blood coagulation and hemostatic disorders, transfusion medicine, infections in hematology, and hematopoietic stem cell transplantation. These sections span 60 smaller groups of diseases or disorders. The EHA Roadmap identifies priorities and needs across the field of hematology, including those to develop targeted therapies based on genomic profiling and chemical biology, to eradicate minimal residual malignant disease, and to develop cellular immunotherapies, combination treatments, gene therapies, hematopoietic stem cell treatments, and treatments that are better tolerated by elderly patients.

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“…To reach this goal, antimicrobial stewardship in the hematology ward is crucial, and yet more difficult than with other patient populations. 323 This requires studies and resources. 3.…”

Section: The Eha Roadmap For European Hematology Researchmentioning

confidence: 99%

The European Hematology Association Roadmap for European Hematology Research: a consensus document

et al. 2016

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“…The use of broad-spectrum antimicrobial agents, particularly β-lactams, is consistently identified as an independent risk factor for MDR Gram-negative infections in oncology patients [10,32,101]. Effective antimicrobial stewardship in oncology programs requires close collaborations between oncologists, infectious diseases physicians, microbiologists, clinical pharmacists, and infection preventionists [102]. Local epidemiology and multidisciplinary expertise should be utilized to develop and implement protocols and treatment algorithms for common scenarios, such as a febrile neutropenia or sepsis.…”

Section: Preventing Mdr Gram-negative Bacterial Infectionsmentioning

confidence: 99%

The growing threat of multidrug-resistant Gram-negative infections in patients with hematologic malignancies

Baker

Satlin

2016

Leukemia & Lymphoma

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Prolonged neutropenia and chemotherapy-induced mucositis render patients with hematologic malignancies highly vulnerable to Gram-negative bacteremia. Unfortunately, multidrug-resistant (MDR) Gram-negative bacteria are increasingly encountered globally, and current guidelines for empirical antibiotic coverage in these patients may not adequately treat these bacteria. This expansion of resistance, coupled with traditional culturing techniques requiring 2-4 days for bacterial identification and antimicrobial susceptibility results, have grave implications for these immunocompromised hosts. This review characterizes the epidemiology, risk factors, resistance mechanisms, recommended treatments, and outcomes of the MDR Gram-negative bacteria that commonly cause infections in patients with hematologic malignancies. We also examine infection prevention strategies in hematology patients, such as infection control practices, antimicrobial stewardship, and targeted decolonization. Finally, we assess strategies to improve outcomes of infected patients, including gastrointestinal screening to guide empirical antibiotic therapy, new rapid diagnostic tools for expeditious identification of MDR pathogens, and use of two new antimicrobial agents, ceftolozane/tazobactam and ceftazidime/avibactam.

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“…Since colonization is the main risk factor for subsequent infection with resistant bacteria, prevention of initial colonization by applying infection control measures is crucial and should be pursued in every cancer center. 114 The main elements of infection control program are outlined in Table 2. Problem recognition is fundamental for choosing effective strategies to prevent nosocomial transmission, thus active surveillance for resistant pathogens should be performed.…”

Section: Othersmentioning

confidence: 99%

“…Problem recognition is fundamental for choosing effective strategies to prevent nosocomial transmission, thus active surveillance for resistant pathogens should be performed. 114 Of note, control of resistant organisms is a national and worldwide problem and requires that facilities which share the same patients work together to prevent transmission of resistant pathogens.…”

Section: Othersmentioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel deescalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.

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The role of antibiotic stewardship in limiting antibacterial resistance among hematology patients

Cited by 93 publications

References 31 publications

The European Hematology Association Roadmap for European Hematology Research: a consensus document

The European Hematology Association Roadmap for European Hematology Research: a consensus document

The growing threat of multidrug-resistant Gram-negative infections in patients with hematologic malignancies

Bloodstream infections in neutropenic cancer patients: A practical update

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