Table 1.

Translational microbiome–based research strategies and interventions to support the management of infectious diseases and antimicrobial administration among high-risk cancer patients

Infectious disease management objectiveMicrobiome research strategy
Risk stratification of patients for infection or colonization with antibiotic-resistant pathogens prior to cancer treatment
  • Develop baseline microbiome disruption indices that take into consideration diversity metrics, absence of beneficial microbial products, domination by microbes related with infection, and other clinical factors, i.e., comorbidities, other medications, previous cancer treatments, etc.

  • Develop models evaluating the effects of antimicrobial administration on microbiota composition, function, and antimicrobial resistance acquisition during cancer therapy

Personalization of antimicrobial administration and infection control decisions for optimal patient outcomes
  • Intensive trials understanding the short- and long-term effects on the microbiome and patient infectious outcomes when using de-escalation of therapy, switching from intravenous to oral therapy, and discontinuation of antimicrobial therapy when cultures are negative

  • Using microbiome measurements or sequencing-based approaches to separate infectious from noninfectious fever

  • Improving methods to be able to catalog an individual's resistome in real time to aid physicians in their therapeutic considerations for prophylaxis and treatment

Infection prevention or microbiome synergism with antimicrobial therapy during cancer treatment
  • Research determining specific probiotic candidates to be used during cancer treatment for desired outcomes

  • Trials understanding the benefits of autologous fecal reimplantation during cancer therapies to prevent infection and development of antibiotic resistance

  • Research defining precise prebiotic candidates or diet manipulation approaches to be used during cancer therapy for preferred outcomes