Infections and antimicrobial prophylaxis in patients with myelodysplastic syndromes

Area of Science:

• Hematology
• Infectious Diseases
• Oncology

Background:

• Infectious complications significantly contribute to morbidity and mortality in myelodysplastic syndromes (MDS).
• Preventing infections can enhance survival and quality of life for MDS patients.
• Assessing infections and antimicrobial prophylaxis in MDS is challenging due to disease heterogeneity and evolving definitions.

Purpose of the Study:

• To review and summarize current understanding of infections and antimicrobial prophylaxis in myelodysplastic syndromes.
• To identify key pathogens and risk factors for infections in MDS patients.
• To provide guidance on appropriate antimicrobial prophylaxis strategies.

Main Methods:

• Literature review and synthesis of existing data on infections in MDS.
• Analysis of infection types, pathogens, and risk factors, including neutropenia.
• Evaluation of current practices and recommendations for antimicrobial prophylaxis.

Main Results:

• Infections in MDS are linked to neutropenia, with higher-risk (HR-MDS) patients experiencing more infections than lower-risk (LR-MDS) patients.
• Pneumonia is the most frequent infection, predominantly caused by bacteria.
• Invasive fungal infections (IFI) and viral reactivation are rare, though antifungal prophylaxis is used for persistent, profound neutropenia.

Conclusions:

• Antibacterial prophylaxis may be considered for HR-MDS patients during severe neutropenia and early therapy cycles.
• Antimicrobial prophylaxis for IFI and viral reactivation is generally less beneficial for most MDS patients.
• Improved data collection on infections and prophylaxis is crucial for optimizing MDS patient care.