Antimicrobial Stewardship in Cancer Patients: A Scoping Review

Cancer patients are at heightened risk for infections due to immunosuppression, often leading to excessive or inappropriate antimicrobial use. An antimicrobial stewardship program (ASP) is essential to optimize therapy, but its implementation in oncology remains challenging and underexplored. Thus, a scoping review was conducted using Arksey and O’Malley’s framework and the Preferred Reporting Items for Systematic Review and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, with an aim to map existing evidence on ASP implementation in oncology settings, focusing on types of interventions, outcomes, and barriers. Searches across PubMed, Scopus, and Web of Science (until July 2024) identified studies on ASP in cancer patients. All original research evaluating stewardship interventions in oncology settings was included. Fifty-six studies from 18 countries were included, comprising diverse study designs and intervention types. Most interventions demonstrated improved antimicrobial appropriateness and reduced usage. Diagnostic interventions, including procalcitonin (PCT) and rapid diagnostics, facilitated targeted therapy. Therapeutic strategies such as de-escalation and prospective audit and feedback (PAF) effectively reduced broad-spectrum antibiotic use. Barriers included limited training, resources, and diagnostic infrastructure. ASP in oncology settings is feasible and beneficial, especially in improving antimicrobial use. Broader adoption requires overcoming systemic barriers, standardizing interventions, and strengthening multidisciplinary collaboration.