ANTIMICROBIAL RESISTANCE PATTERNS IN HEMATO ONCOLOGY: A COMPREHENSIVE REVIEW

Abstract

Background: Hematological malignancies and their therapies have improved survival outcomes, yet infections remain a major cause of morbidity and mortality. Immunosuppression, invasive devices, and prolonged hospitalizations predispose patients to antimicrobial-resistant pathogens. With rising prevalence of multidrug resistant organisms (MDROs), effective infection management in hemato-oncology is increasingly complex. Methods A systematic search of PubMed, Scopus, and Google Scholar was conducted for studies published between 2014 and 2025. Eligible studies included observational cohorts, clinical trials, and case reports reporting antimicrobial resistance (AMR) in hemato-oncology populations. Data extraction focused on study characteristics, pathogens, resistance patterns, and clinical outcomes. Methodological quality was assessed using the Newcastle–Ottawa Scale, and findings were synthesized narratively. Results: Gram-negative organisms, particularly Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii, accounted for the majority of bloodstream infections, with extended spectrum β-lactamase (ESBL) and carbapenem resistance highly prevalent. Among Gram-positive bacteria, methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative staphylococci, and vancomycin resistant Enterococcus (VRE) were frequently reported. Emerging fungal resistance, including azole-resistant Aspergillus and multidrug-resistant Candida auris, further compromised management. Resistant infections were associated with prolonged hospitalization, ICU admission, and high mortality, with multidrug-resistant Gram negative bacteremia showing mortality rates up to 42%. Resistance trends varied geographically, with higher prevalence in low- and middle-income countries. Conclusion: Antimicrobial resistance significantly worsens clinical outcomes in hemato-oncology patients. Local resistance surveillance, robust antimicrobial stewardship, infection control, and tailored empiric therapy are essential to mitigate morbidity and mortality. Multicenter prospective studies are needed to strengthen global evidence and inform policy.