Prevention and treatment of bacterial infections in patients with haematological cancers and hematopoietic stem cell transplantation: headways and shortcomings

There has been an unprecedented increase of immunocompromised (IC) patients in clinical practice due to various reasons. Bacterial infections are a major cause of morbidity and mortality in this population. Emerging antibacterial resistance poses a significant challenge for prophylaxis and treatment. We aim to provide an update on antibacterial prophylaxis and management, particularly in high-risk IC patients, including those with acute leukaemia and haematopoietic stem cell transplantation. We reviewed original articles, systematic reviews, metanalyses and guidelines using PubMed, Scopus and Web of Science. We discussed the pros and cons of fluoroquinolone (FQ) prophylaxis in neutropenic patients in the context of personalized medicine. We also attempted to give an outline of empirical treatment of presumed bacterial infections and targeted therapy options for documented bacterial infections considering the recent surge of multiresistant bacteria in haematological cancer patients and local epidemiology. The shortcomings of the current strategies and future needs are discussed in detail. Antibacterial prophylaxis with FQs may still have a role in preventing bacterial infections in carefully selected high-risk haematology patients. Empirical treatment algorithms still need to be adjusted according to host and local factors. Use of rapid diagnostic methods may lessen the need of broad spectrum empirical antibiotic usage. However, these tests may not be easily available due to budget constraints in countries with limited resources but high rate of the bacterial resistance. Although new antimicrobials provide opportunities for effective and less toxic treatment of highly resistant bacterial infections, large-scale data from IC patients are very limited. Using data-driven approaches with AI tools may guide the selection of appropriate patients who would benefit most from such prophylactic and treatment regimens.