#41 – The Gray Zone: Antimicrobial Stewardship in Immunocompromised Hosts

Promoting evidence-based antimicrobial stewardship for patients with immunocompromising conditions can be tricky when they’re often excluded from clinical studies. Dr. Zahra Kassamali Escobar (@ZKEPharmD) explores this gray zone with Dr. Catherine Liu and Dr. Justine Ross (@abella_ross) References: Fluoroquinolone Prophylaxis  Bucaneve et al. Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med 2005; 353:977-87. DOI: 10.1056/NEJMoa044097  Cullen et al. Antibacterial prophylaxis after chemotherapy for solid tumors and lymphomas. N Engl J Med 2005; 353:988-98. DOI: 10.1056/NEJMoa050078  Drayson et al. Levofloxacin prophylaxis in patients with newly diagnosed myeloma (TEAMM): a multicenter, double-blind, placebo-controlled, randomized, phase 3 trial. Lancet Oncology  2019; 20(12):1760-72. DOI: 10.1016/S1470-2045(19)30506-6 Satlin et al. Colonization with fluoroquinolone-resistant enterobacterales decreases the effectiveness of fluoroquinolone prophylaxis in hematopoietic cell transplant recipients. Clin Infect Dis 2021 May 6. doi: 10.1093/cid/ciab404.  Antibiotic Treatment and Microbiome Implications Aguilar-Guisado M, et al. Optimisation of empirical antimicrobial therapy in patients with haemotological malignancies and febrile neutropenia (How Long study): an open-label, randomized, controlled, phase 4 trial. Lancet Haematol. 2017 Dec;4(12):e573-83. doi: 10.1016/S2352-3026(17)30211-9. Shono et al. Gut microbiome injury in allogeneic haematopoietic stem cell transplantation. Nat Rev Cancer. 2018;18(5):283-95. doi: 10.1038/nrc.2018.10.  Weber et al. Microbiome disruption induced by early use of broad-spectrum antibiotics is an independent risk factor of outcome after allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2017;23(5):845-52. doi: 10.1016/j.bbmt.2017.02.006  Pinato et al. Association of prior antibiotic treatment with survival and response to immune checkpoint inhibitor therapy in patients with cancer. JAMA Oncol. 2019;5(12):1774-78. doi:10.1001/jamaoncol.2019.2785   Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/