Bacterial infections in patients with
hematologic malignancies still represent a severe and life-treating problem. Several observational studies during the last decade have revealed that neutropenic patients with
fever are a heterogeneous population with various differences regarding response to initial
therapy, development of serious complications and mortality. The role of
neutropenia as main risk factor for
infections in hematologic patients and the definition of different level of risk related to neutrophils count and duration of
neutropenia have been extensively studied and different categories of patients based on the risk of
infection, mostly the condition of
neutropenia, have been clearly defined. The strategies on antimicrobial
therapy and supportive care in hematologic patients need to be continuously assessed, in fact new conditions favouring the occurrence of infectious complications in patients with
hematologic malignancies have progressively emerged. The use of oral prophylactic
antibiotics in neutropenic
cancer patients is still a matter of debate. Before 2005, several trials showed how the prevention of
infection can be extremely important in this setting of patients but none was conclusive. In 2005 two meta-analysis and two large randomized clinical trials gave new evidence that antibacterial prophylaxis can reduce in neutropenic patients several important outcomes including mortality. The use of the empiric antibacterial
therapy represents the cornerstone of the antimicrobial strategies in the febrile neutropenic patients leading, over the span of 20 years, to a dramatic decrease of deaths: Actually
beta-lactam monotherapy is commonly used for the empiric treatment of
febrile neutropenia. Recently, large randomized clinical trials and meta-analysis showed that the addition of an
aminoglycoside and/or a
glycopeptides results in a more favourable outcome only in selected severe
infections. The use of
antibiotics should be prudent and safe also in neutropenic hematologic patients to prevent emergence of microbial resistance, to save costs, to reduce toxicity. For this reasons, according to the evidence, antibacterial prophylaxis should be restricted to high risk hematologic patients and empiric parenteral
antibiotic monotherapy should be recommended in case of
febrile neutropenia limiting the use of amynoglicosides and
glycopeptides. In the next future, a major effort should be made to state in hematologic patients new risk factors which could more accurately define subgroups for targeted anti-infective strategies.