The Rising Challenge of Multidrug-Resistant Gram-Negative Infections in the Outcome of Hematological Oncology: A Review

Abstract

Bloodstream infections (BSIs) caused by Gram-negative bacteria (GNB) are a significant concern in patients with hematological malignancies (HM), particularly when multidrug-resistant (MDR) strains are involved. This review synthesizes key findings from studies investigating the epidemiology, clinical implications, and management strategies for GNB BSIs in HM patients. The reviewed studies shows the heightened mortality risk associated with GNB BSIs, especially in the context of immunocompromised HM patients. Studies highlight the prevalence of MDR GNB, including ESBL, AmpC β-lactamase, and carbapenemase-producing strains, which pose challenges to standard antibacterial therapies. Importantly, the review identifies the need for routine blood culture monitoring, personalized risk assessment, and tailored antimicrobial policies to optimize patient outcomes. Most important MDR groups identified were Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species, Stenotrophomonas maltophilia, Proteus species. Future research directions include enhancing surveillance systems, developing innovative therapeutic approaches, personalized medicine strategies, strengthening infection control measures, optimizing antimicrobial prophylaxis, and investigating antibiotic-resistant strains and gene identification.