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Review
. 2025 Aug 7.
doi: 10.1007/s40121-025-01204-4. Online ahead of print.

Can We Lower the Burden of Antimicrobial Resistance (AMR) in Heavily Immunocompromised Patients? A Narrative Review and Call to Action

Matteo Bassetti  1 , Antonella Cardone  2 , Fatima Cardoso  3 , Vanessa Carter  4 , Oliver A Cornely  5 , Marco Falcone  6 , Daniel Gallego  7 , Maddalena Giannella  8 , Paolo Antonio Grossi  9 , Livio Pagano  10 , Nicola Silvestris  11 , Nikolaos V Sipsas  12 , Alex Soriano  13 , Mario Tumbarello  14 , Pierluigi Viale  8
Affiliations
Review

Can We Lower the Burden of Antimicrobial Resistance (AMR) in Heavily Immunocompromised Patients? A Narrative Review and Call to Action

Matteo Bassetti et al. Infect Dis Ther. .

Abstract

Effective antibiotics are a cornerstone of treatment for heavily immunocompromised patients such as those undergoing cancer treatment or transplantation procedures, as these patients are at particularly high risk of adverse outcomes from infections. However, rising antimicrobial resistance (AMR) threatens to undermine our ability to deliver modern treatments, and without action, recent advances in clinical care may be undone. In this narrative review, we examine the broad burdens of AMR for patients and healthcare systems, including excess mortality, underlying disease outcomes, economic costs and the damage to patients' quality of life. Despite the profound impact on individual wellbeing, the patient voice and patient-reported experience measures are largely absent from current research. To protect the everyday benefits of antibiotics, it is vital to educate all those involved in patient care on how we can combat AMR, including appropriate testing, use of effective antibiotics and infection control procedures. Moreover, given the high investment in novel anticancer treatments, good antimicrobial stewardship has the potential to deliver overall cost savings to healthcare systems while ensuring that patients can safely access and benefit from these therapies.

Keywords: Antimicrobial resistance; Cancer; Haematological; Immunocompromised; Multidrug resistance; Transplant.

Plain language summary

Antibiotics are essential for people with serious health conditions like cancer or those who have received an organ transplant. These patients have weakened immune systems and are more likely to develop infections; however, antimicrobial resistance (AMR), where bacteria no longer respond to antibiotics, is making these infections harder to treat. This review looked at the impact of AMR in heavily immunocompromised patients. It found that resistant infections are common and can cause delays to cancer treatment, longer hospital stays and a higher risk of death. These infections can also reduce quality of life and increase healthcare costs. The review found that current efforts to manage AMR are inconsistent. There is a need for faster diagnostic testing, better education for healthcare providers and patients, and more consistent use of infection control and antibiotic stewardship programmes. These steps could help optimise the treatment of resistant bacteria and improve outcomes. As treatments like chemotherapy and organ transplantation are very costly, preventing infections and early mortality through better AMR management could also help reduce overall healthcare spending. The review highlights the importance of improving awareness, strengthening hospital systems and investing in new antibiotics so that patients continue to benefit from modern medical treatments.

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Conflict of interest statement

Declarations. Conflict of Interest: Matteo Bassetti has received payment or honoraria, and has participated on Data Safety Monitoring Boards or Advisory Boards for Angelini, Cidara, Gilead, Menarini, MSD, Pfizer, Shionogi and Mundipharma, and is an Editorial Board member of Infectious Diseases and Therapy. Matteo Bassetti was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Fatima Cardoso has received consulting fees from Amgen, Astellas/Medivation, AstraZeneca, Celgene, Daiichi-Sankyo, Eisai, GE Oncology, Genentech, Gilead, GlaxoSmithKline, Iqvia, Macrogenics, Medscape, Merck-Sharp, Merus BV, Mylan, Mundipharma, Novartis, Pfizer, Pierre-Fabre, prIME Oncology, Roche, Sanofi, Samsung Bioepis, Seagen, Teva and Touchime. Vanessa Carter has received a grant from bioMérieux, received consulting fees from the Centre for Infectious Disease Research and Policy (CIDRAP), the University of Cape Town, TB HIV Care, the South African Heart Association, the South African Transplant Society, the International Pediatrics Association, Malcolm Lyons and Brivik Attorneys, and TB Proof South Africa, received payment or honoraria from Cepheid, bioMérieux, Menarini, Pfizer, NHS Wales, the SA Association of Hospital Industry Pharmacists (SAAHIP), the AMR Patient Group EU, BioCodex, the Fleming Initiative/Imperial College, CARB-X 2024, the Norwegian Institute of Public Health, Reckitt South Africa, the Institute for Infections & Immunity at St George’s University of London, Roche, the Association de gestion du musée de Sciences Biologiques Dr Mérieux, the Department of Clinical Microbiology and Infectious Diseases in Johannesburg, Manchester University and Medscape, support for attending meetings from British Society for Antimicrobial Chemotherapy (BSAC), the Fleming Initiative, the European Patients Forum and the WHO, held leadership or fiduciary roles in the Advisory Committee on Antimicrobial Prescribing, Resistance, and Healthcare-Associated Infection (APRHAI) committee, WHO Task Force of AMR Survivors, WHO-STAG, the AMR Narrative and the Commonwealth Pharmacy Association, and received equipment, materials, drugs, medical writing, gifts or other services from Metro UK. Oliver A. Cornely has received grants or contracts from iMi, iHi, DFG, BMBF, Cidara, DZIF, EU-DG RTD, F2G, Gilead, MedPace, MSD, Mundipharma, Octapharma, Pfizer and Scynexis, received consulting fees from Abbvie, AiCuris, Basilea, Biocon, Cidara, Seqirus, Gilead, GSK, IQVIA, Janssen, Matinas, MedPace, Menarini, Molecular Partners, MSG-ERC, Mundipharma, Noxxon, Octapharma, Pardes, Partner Therapeutics, Pfizer, PSI, Scynexis, Seres, Elion Therapeutics and Melinta, received payment or honoraria from Abbott, Abbvie, Akademie für Infektionsmedizin, Al-Jazeera Pharmaceuticals/Hikma, amedes, AstraZeneca, Deutscher Ärzteverlag, Gilead, GSK, Grupo Biotoscana/United Medical/Knight, Ipsen Pharma, Medscape/WebMD, MedUpdate, MSD, Moderna, Mundipharma, Noscendo, Paul-Martini-Stiftung, Pfizer, Sandoz, Seqirus, Shionogi, streamedup!, Touch Independent and Vitis, received payment for expert testimony from Cidara, and participated on a Data Safety Monitoring Board or Advisory Board for Boston Strategic Partners, Cidara, IQVIA, Janssen, MedPace, PSI, Pulmocide, Shionogi, The Prime Meridian Group, Vedanta Biosciences, AstraZeneca and Melinta. Marco Falcone has received consulting fees from Menarini, Shionogi and Pfizer, and received payment or honoraria from MSD, Menarini, Pfizer and Thermo Fisher. Maddalena Giannella has received payment or honoraria from Shionogi, MSD, Pfizer and Menarini. Paolo Antonio Grossi has received consulting fees from MSD, Takeda, Gilead Sciences, AstraZeneca and AlloVir, and received payment or honoraria from MSD, Takeda, AstraZeneca and Menarini. Livio Pagano has received a grant or contract from Gilead, received payment or honoraria from Gilead, Jazz, Gentili, Cidara, Pfizer, 2FG, AstraZeneca and Menarini-Stemline, and participated on Data Safety Monitoring Boards or Advisory Boards for Cidara and Pulmocide. Nicola Silvestris has received payment or honoraria from Editree, Effetti, Sanitanova, Vihtali, Aristea, Pharmalex, Agorà, Menarini, Servier, Bristol, Glaxo, Isheo and MSD, received support for attending meetings and/or travel, and has other financial or non-financial interests with the Italian Association of Medical Oncology. Nikolaos V. Sipsas has received payment or honoraria, and support for attending meetings and/or travel from Menarini, and has held a leadership or fiduciary role in the Hellenic Society for Infectious Diseases. Alex Soriano had received grants from Gilead Sciences and Pfizer, received consulting fees and payment or honoraria from Pfizer, MSD, Angelini, Shionogi, Gilead and Menarini, received support for attending meetings and/or travel from Pfizer, and is an Editor-in-Chief of Infectious Diseases and Therapy. Alex Soriano was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Pierluigi Viale received consulting fees from Menarini, MSD, Pfizer, Gilead, AstraZeneca, Shionogi and Advanz Pharma, and received payment or honoraria from Gilead, bioMérieux, Pfizer, Shionogi, Menarini and Advanz Pharma. Antonella Cardone, Daniel Gallego and Mario Tumbarello declare no conflicts of interest. Ethical Approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. No new data were generated.

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