Abstract
Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the management of refractory hematologic malignancies such as leukemia, lymphoma and multiple myeloma, offering unprecedented remission rates. Yet, complications arising from infections remain a major challenge, particularly in the early post-infusion period and during prolonged immune suppression. This editorial synthesizes recent evidence (2021–2025) on infection epidemiology, risk factors, and stewardship strategies in CAR T-cell recipients. Early infections, especially from bacteria are influenced by neutropenia, prior therapy, and disease biology, while long-term immune suppression of CD4+ T cells help sustain vulnerability. Antibiotic stewardship presents a critical opportunity to reduce unnecessary exposure through biomarker-guided diagnostics and de-escalation protocols. Rising cases of antimicrobial resistance and dysbiosis pose significant challenges, while emerging diagnostic technologies and microbiome-focused interventions offer promise. Future strategies should be focused on integrating clinical vigilance, harmonized prophylaxis, and microbiome-awareness stewardship to optimize both safety and efficacy in CAR T-cell therapy.