Best practice points for antimicrobial stewardship and infection prevention: a multidisciplinary approach to supportive care in patients with neutropenic fever

This chapter aims to provide an updated framework for whole-of-hospital neutropenic fever management, outlining best-practice principles to guide the integration of antimicrobial stewardship, infection prevention, microbiology, pharmacy and nursing within the multidisciplinary care of patients with neutropenic fever. A comprehensive literature search was performed using PUBMED, prioritising randomised controlled trials and notable observational studies since 2011. Hospital antimicrobial stewardship programmes can significantly improve neutropenic fever care through personalised approaches and decision support tools which consider individual risk profiles, colonisation status and infection history to guide precise empiric therapy decisions. Key aspects include pre-chemotherapy antibiotic allergy assessments, appropriate use of cephalosporins in certain allergy cases, and specialised evaluation for severe reactions. The microbiology laboratory plays a crucial role in pathogen diagnosis and surveillance for drug resistance including formulation of antibiograms. Infection prevention and control measures, including adherence to national standards and local protocols, are critical in reducing hospital-acquired infections. Optimised antimicrobial dosing should be implemented, considering patient-specific factors and utilising therapeutic drug monitoring. Advanced practice nurses can significantly contribute to patient experience through direct management and education. The management of NF requires a cohesive hospital-wide strategy that goes beyond the actions of individual clinicians and draws on the collective expertise of various disciplines. These guidelines underscore the importance of a structured systems approach.