Discussing the appropriateness of antimicrobial treatment and multidrug-resistant organisms: a six-month flash insight on infections occurring in the Hematology Department

Background Increasing numbers of infections from multi-drug-resistant organisms constitute a rising worldwide emergency; hospital wards, such as the Hematology Department, are mostly involved. The intensive treatment strategies developed to induce the remission of hematologic malignancies result in a transient state of altered immunological defenses (affecting both cellular immunity and the host’s mechanical barriers) that temporarily opens the gate to infectious complications. As new treatment options are adopted, different shades of acquired immunodeficiency emerge, thus continuously changing the spectrum of the involved pathogens. The type of infections occurring in HSCT recipients depend on the time elapsed since transplantation: the pre-engraftment, the early and the late post-engraftment periods are characterized peculiar clinical syndromes, each involving different pathogens. Among all the risk factors described in literature, the neutropenia that results from the malignancy itself or that develops as a complication of chemotherapy substantially increases the susceptibility to bacterial and fungal infections (most commonly enteric bacteria and fungi, such as Candida and Aspergillus). The use of central venous catheters represents a further risk factor for bacterial and fungal infections (notably by Staphylococcal and Candida species). These three main factors make patients with malignancies the hematologic population most frequently affected by infectious complications; these are indeed frequently described, and infection is reported as the primary cause of death in 7% of autologous HCT patients and 14% to 17% of allogeneic HCT recipients, despite the commonly adopted antibiotic and anti-fungal prophylactic measures. Limited drug choice options and costs make a pondered use of antibiotic therapy mandatory. Aim of the study The main goal is to ponder the present antibiotic stewardship strategy applied in the ward under observation, discussing its appropriateness in infection control.