Antibiotic resistance in cancer patients

Abstract

Bacterial infection is one of the most frequent complications in cancer patients and hematopoietic stem cell transplant recipients. In recent years, the emergence of antimicrobial resistance has become a significant problem worldwide, and cancer patients are among those affected. Treatment of infections due to multidrug-resistant (MDR) bacteria represents a clinical challenge, especially in the case of Gram-negative bacilli, since the therapeutic options are often very limited. As the antibiotics active against MDR bacteria present several disadvantages (limited clinical experience, higher incidence of adverse effects, and less knowledge of the pharmacokinetics of the drug), a thorough acquaintance with the main characteristics of these drugs is mandatory in order to provide safe treatment to cancer patients with MDR bacterial infections. Nevertheless, the implementation of antibiotic stewardship programs and infection control measures is the cornerstone for controlling the development and spread of these MDR pathogens.

Keywords::

• antibiotic resistance
• antibiotic therapy
• bacterial infection
• cancer
• mortality
• neutropenia
• prognosis

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Recently, the emergence of antimicrobial resistance has become a health problem worldwide. Cancer patients and hematopoietic stem cell transplantation recipients are among those affected.

• Infections due to multidrug-resistant (MDR) Gram-negative bacteria are of special concern, since the therapeutic options are often very limited.

• Several studies have shown that cancer patients infected with resistant bacteria more often receive inadequate initial empirical antibiotic therapy, which may impair outcomes, increase mortality and prolong hospitalization.

• Before choosing initial empirical antibiotic therapy for febrile neutropenia, physicians need to assess the risk for complications of severe infection by using the Multinational Association for Supportive Care in Cancer index score or by clinical judgment.

• The recently published European Conference on Infections in Leukaemia guidelines recommend using an escalation or de-escalation approach for the initial empirical antibiotic therapy for febrile neutropenia, based on the epidemiological data and resistance patterns, the patient’s condition and the presence of risk factors for antimicrobial resistance.

• The antibiotics active against MDR bacteria have several disadvantages, including limited clinical experience, a higher incidence of adverse effects and less knowledge of the pharmacokinetics of the drug. Therefore, a thorough acquaintance with the main characteristics of these drugs is essential in order to safely treat cancer patients with MDR bacterial infections.

• Implementation of antibiotic stewardship programs and infection control measures is required in order to prevent the development and dissemination of antimicrobial resistance.