Tackling antimicrobial resistance in people who are immunocompromised: leveraging diagnostic and antimicrobial stewardship - 12/08/25

Doi : 10.1016/S1473-3099(25)00311-1

Catherine Liu, ProfMD ^a,^b,⁎ , Emily A Rosen, MD ^a,^b, Erica J Stohs, MD ^c, Hannah Imlay, MD ^d, Masayuki Nigo, MD ^e, Lee S Gottesdiener, MD ^f, Miranda So, PharmD ^g, Frank Tverdek, PharmD ^a,^b, Sanjeet Dadwal, ProfMD ^h, Carlota Gudiol, ProfPhD ^i,^j,^k, Michael J Satlin, MD ^f, Susan K Seo, ProfMD ^l, Jason A Trubiano, ProfPhD ^m, Ritu Banerjee, ProfMD ⁿ, Kimberly E Hanson, ProfMD ^d, Lilian M Abbo, ProfMD ^o
^a Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
^b University of Washington, Seattle, WA, USA
^c Creighton University Medical Center, Omaha, NE, USA
^d University of Utah School of Medicine, Salt Lake City, UT, USA
^e Houston Methodist Hospital, Houston, TX, USA
^f Weill Cornell Medicine, New York, NY, USA
^g University Health Network, University of Toronto, Toronto, ON, Canada
^h City of Hope, Duarte, CA, USA
ⁱ Department of Infectious Diseases, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
^j Bellvitge Biomedical Research Institute (IDIBELL) L’Hospitalet de Llobregat, Institut Català d’Oncologia, Barcelona, Spain
^k Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
^l Memorial Sloan Kettering Cancer Center, New York, NY, USA
^m Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, University of Melbourne, Melbourne, VIC, Australia
ⁿ Vanderbilt University Medical Center, Nashville, Tennessee, USA
^o Jackson Health System, University of Miami School of Medicine, Miami, FL, USA

^*Correspondence to: Prof Catherine Liu, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USAVaccine and Infectious Disease DivisionFred Hutchinson Cancer CenterSeattleWA98109USA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 12 August 2025

Summary

Antimicrobial resistance (AMR) disproportionately affects people who are immunocompromised due to their frequent encounters with the health-care system and repeated, prolonged exposure to antibiotics. AMR threatens to undermine continued advances in cancer care, haematopoietic cell transplantation, and solid organ transplantation by severely restricting therapeutic options. The convergence of several factors in the diagnostic evaluation of infection among individuals with immunocompromising conditions contributes to excess and inappropriate antibiotic use. Diagnostic and antimicrobial stewardship are key complementary strategies to address these challenges with shared goals of improving patient outcomes, reducing harm, and mitigating the risk of AMR. In this Series paper, we discuss opportunities to enhance use of existing diagnostic tools (eg, culture-based diagnostics, molecular diagnostics, and other tools such as antibiotic allergy delabelling), emerging diagnostic tools (eg, metagenomic sequencing and host response profiling), and digital innovation, to optimise antibiotic use, and the potential for precision medicine approaches to combat AMR in people who are immunocompromised.

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