How Are Antibiotic Stewardship Efforts Different for Immunocompromised Patients?

Lilian Abbo, MD, chief, infection prevention & control and antibiotic stewardship, Jackson Health System, associate professor of clinical medicine, Division of Infectious Diseases, Miller School of Medicine, University of Miami, explains how antibiotic stewardship efforts are different in the immunocompromised population.

Interview Transcript (slightly modified for readability)

“Antimicrobial stewardship in the immunocompromised population is a little more challenging than [in] the general population. Why? Immunocompromised patients sometimes don’t manifest the same symptoms as someone [who is] immunocompetent. They may not have a very high fever, they may not have a very high white [blood cell] count. The patient may not look as sick, but once they become sick, they become really sick. By the time you start noticing, sometimes they become septic, so you have to act very quickly.

Making a real diagnosis and trying to identify what’s causing the infection is extremely important in this population. Sometimes you have to do more invasive tests. These patients sometimes are exposed to antibiotics, a lot of times for prophylaxis to prevent infections (very appropriately); they may come from different facilities, we may have traveling, tourism, people who go for medical care from different hospitals, for example, who go to different hospitals many times. So, it’s a population that is already colonized or infected with multidrug-resistant bugs.

If you’re going to do stewardship [you should know] what is stewardship. It’s making sure that you give the patient the right antibiotic, in the right time, for the appropriate duration when they really need it.

So, you need to work [with the] understanding that this is a population that can get very sick if we don’t give them timely antibiotics, that you need to pick the right drug, that it’s extremely important, that you need to make the right diagnosis, and that you need to partner with your colleagues, who, as you, want to do the right thing for your patient. [For example, work with] your oncologist, your surgeons, your pharmacists, pulmonologists, nephrologists, hepatologists, pediatricians, who all collectively need to come together and find out, ‘for our population, for our setting, how do we do this? We can’t stop antibiotics because the patient is neutropenic and still has a fever. What are the best guidelines, how do we broaden the spectrum, how do we narrow the spectrum?’

So, it’s a little different than doing stewardship in other populations, but it’s doable, it just takes a little more time.”