Noninfectious causes of fever in hematologic malignancies. Are antibiotics still indicated? Review
| Authors: | Shahid, Z.; Epstein, D. J. |
| Review Title: | Noninfectious causes of fever in hematologic malignancies. Are antibiotics still indicated? |
| Abstract: | Purpose of reviewFever is a common manifestation of both infectious and noninfectious processes in recipients of hematopoietic cell transplantation (HCT) and chimeric antigen receptor T-cell (CAR-T) therapy. Understanding the diverse causes of fever in these settings allows for accurate diagnosis and optimal use of antibiotics.Recent findingsHerein we review common noninfectious syndromes seen in HCT and CAR-T recipients and discuss best practices in the management of these complex clinical scenarios regarding diagnosis and antibiotic use. In recent years, adverse effects of antimicrobials have highlighted the importance of antimicrobial stewardship in HCT and CAR-T patients, and an antibiotic de-escalation strategy is a safe and important tool in mitigating these adverse events, even in patients with ongoing neutropenia who become afebrile without a known infection. Common adverse events associated with antibiotics include an increased risk of Clostridiodes difficile infection (CDI), a higher incidence of multidrug-resistant organisms (MDROs), and microbiome dysbiosis.SummaryClinicians should be aware of noninfectious causes of fever in these immunocompromised patients and utilize best antibiotic practices while managing these patients. © 2023 American Association of Neuroscience Nurses. Unauthorized reproduction of this article is prohibited. |
| Keywords: | antibiotic agent; antibiotic therapy; neutropenia; review; drug safety; nonhuman; hematopoietic stem cell transplantation; drug fever; fever; pneumonia; antiinfective agent; anti-bacterial agents; acute graft versus host disease; blood transfusion reaction; hematologic malignancy; hematologic neoplasms; chimeric antigen receptor; diagnostic test; hematologic disease; hemophagocytic syndrome; complication; idiopathic disease; engraftment syndrome; cytokine release syndrome; antimicrobial stewardship; humans; human; tisagenlecleucel t; chimeric antigen receptor t-cell immunotherapy; axicabtagene ciloleucel; lisocabtagene maraleucel; receptors, chimeric antigen; brexucabtagene autoleucel; ciltacabtagene autoleucel; idecabtagene vicleucel; chimeric antigen receptor therapy; noninfectious fever; unnecessary prescribing |
| Journal Title: | Current Opinion in Infectious Diseases |
| Volume: | 36 |
| Issue: | 4 |
| ISSN: | 0951-7375 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2023-08-01 |
| Start Page: | 209 |
| End Page: | 217 |
| Language: | English |
| DOI: | 10.1097/qco.0000000000000940 |
| PUBMED: | 37431551 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Review -- Source: Scopus |
