Background In recent years, antimicrobial resistance and the limited number of new antimicrobials under development have profoundly complicated treatment options especially in patients with hematologic malignancies that are treated with sequential courses of antimicrobial therapy. These issues emphasize on the importance of surveillance studies to monitor antimicrobial resistance and implement the antimicrobial stewardship strategies in health care centers. Methods The study was a prospective cohort with the aim of evaluating the microbiological spectrum of infection-related febrile episodes in adult patients with hematologic malignancies who admitted in a 1000-bed teaching hospital affiliated to Mashhad University of Medical Sciences, Iran. Results One hundred eight infection-related febrile episodes were identified in 108 individuals with hematologic malignancies of whom 18.5% had bacteremia. The most commonly isolated pathogens were coagulase-negative staphylococci (40%), followed by Escherichia coli (25%), and Klebsiella spp (10%), respectively. Carbapenems and glycopeptides were prescribed in the empirical regimen of 96.4% and 61.2% of patients. Although more than 67% of them needed to be deescalated at the second key time of antimicrobial therapy, it was performed only in 9%. Conclusions Our study highlighted the high rates of prescription of broad-spectrum antimicrobials in the empirical regimen of patients and a poor adherence to appropriate deescalation strategies after the second key time point of antimicrobial therapy among physicians in charge of patients with hematologic malignancies. It also emphasizes the importance of developing infrastructure for implementation and adherence to antimicrobial stewardship strategies in hematologic malignancy wards in developing countries such as Iran.

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