Antimicrobial Stewardship in Patients with Hematological Malignancies: Key Considerations

Purpose of reviewThis 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 findingsThere 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.SummaryAntimicrobial 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.