Empirical and targeted antimicrobial therapy in patients with febrile neutropenia and haematological malignancy or after haematopoietic cell transplantation: recommendations from the 10th European Conference on Infections in Leukaemia - 26/11/25

Doi : 10.1016/S1473-3099(25)00619-X

Dina Averbuch, ProfMD ^a,^b,^c,^{^{†
Joint corresponding authors},}⁎ , Yuri Vanbiervliet, MD ^d, Francesco Baccelli, MD ^e,^f, Malgorzata Mikulska, PhD ^g,^h, Dionysios Neofytos, ProfMD ⁱ, Carolina Garcia-Vidal, ProfPhD ^j,^k,^l, Manuela Aguilar-Guisado, ProfPhD ^l,^m, Nicole Blijlevens, ProfMD ⁿ, Patricia Munoz, ProfMD ^o,^p,^q,^r, Catherine Cordonnier, ProfMD ^s, Murat Akova, ProfMD ^t,^u, Thierry Calandra, ProfMD ^v,^{^{†
Joint corresponding authors},}⁎
^a Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
^b Pediatric Infectious Diseases, Hadassah Medical Center, Jerusalem, Israel
^c Infectious Diseases Working Party EBMT, Department of Hematology University Hospitals of Leuven, Leuven, Belgium
^d Department of Microbiology, Immunology and Transplantation KU Leuven, Department of Hematology University Hospitals of Leuven, Leuven, Belgium
^e Pediatric Hematology and Oncology, Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero–Universitaria di Bologna, Bologna, Italy
^f Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
^g Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
^h Department of Health Sciences, University of Genoa, Genoa, Italy
ⁱ Division of Infectious Diseases, Transplant Infectious Disease Unit, University Hospital of Geneva, Geneva, Switzerland
^j Infectious Disease Department, Hospital Clinic of Barcelona–August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
^k Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
^l Centro de Investigación Biomédica en Red Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
^m Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Instituto de Biomedicina de Sevilla (IBiS), Virgen del Rocío University Hospital, Consejo Superior de Investigaciones Científicas, University of Seville, Seville, Spain
ⁿ Department of Hematology, Radboud University Medical Centre, Nijmegen, Netherlands
^o Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
^p Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
^q Centro de Investigación Biomédica en Red Enfermedades Respiratorias–Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
^r Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
^s Hematology Department, University Paris-Est Créteil, Creteil, France
^t Hacettepe University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
^u International Immunocompromised Host Society, Pittsburgh, PA, USA
^v Service of Immunology and Allergy, Department of Medicine and Department of Laboratory Medicine and Pathology, Center for Human Immunology Lausanne, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland

^*Correspondence to: Prof Dina Averbuch, Pediatric Infectious Diseases, Hadassah Medical Center, 91120 Jerusalem, IsraelPediatric Infectious DiseasesHadassah Medical CenterJerusalem91120Israel^**Prof Thierry Calandra, Service of Immunology and Allergy, Department of Medicine and Department of Laboratory Medicine and Pathology, Center for Human Immunology Lausanne, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, SwitzerlandService of Immunology and AllergyDepartment of Medicine and Department of Laboratory Medicine and PathologyCenter for Human Immunology LausanneLausanne University HospitalUniversity of LausanneLausanne1011Switzerland

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 26 November 2025

Summary

Febrile neutropenia can lead to life-threatening infections in patients with haematological malignancies or after hematopoietic cell transplantation. Infection management is challenged by rising antibiotic resistance and regional differences in bacterial epidemiology. The 10th European Conference on Infections in Leukaemia panel recommends a personalised approach guided by local resistance patterns and individual risk factors. For patients who are haemodynamically stable without colonisation or infection by resistant Gram-negative bacteria in low-resistance prevalence settings, empirical monotherapy sparing carbapenems or novel β-lactams with or without β-lactamase inhibitors (BLI) is recommended. For patients who are critically ill or haemodynamically unstable, those with previous resistant Gram-negative bacteria colonisation or infection, or in high-resistance prevalence settings, broader-spectrum therapy is indicated. Treatment options include β-lactam plus aminoglycoside combinations, carbapenem with or without BLI, anti-pseudomonal cephalosporin and BLI combinations, or cefiderocol, individualised by local epidemiology and patient factors. Antimicrobial stewardship is recommended, including antimicrobial de-escalation once resistant Gram-negative bacteria infection is excluded; and antibiotic discontinuation regardless of neutrophil count, in patients who are afebrile and stable after completing the intended course. We provide treatment strategies for resistant Gram-negative bacteria infections.

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