Risk factors for extended-spectrum beta-lactamase-producing Enterobacteriaceae infection causing septic shock in cancer patients with chemotherapy-induced febrile neutropenia

  • Youn-Jung Kim
  • Sung Min Jung
  • Jihoon Kang
  • Seung Mok Ryoo
  • Chang Hwan Sohn
  • Dong-Woo Seo
  • Kyoung Soo Lim
  • Jin Won Huh
  • Sung-Han Kim
  • Won Young KimEmail author


Patients with chemotherapy-induced febrile neutropenia (FN) are vulnerable to extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBL-PE) infection. Early identification of patients suspected to have ESBL-PE infection for empirical carbapenem administration is crucial; nevertheless, risk factors for ESBL-PE causing septic shock remain unclear. We identify factors to predict ESBL-PE in septic shock patients with chemotherapy-induced FN. In this observational, prospectively collected registry-based study, consecutive adult chemotherapy-induced FN patients with septic shock who were admitted to the emergency department between June 2012 and June 2018 were enrolled. Clinical and laboratory data extracted from the septic shock registry were assessed to identify risk factors for ESBL-PE. Of 179 chemotherapy-induced FN septic shock patients, ESBL-PE is isolated in 23 (12.8%). ESBL-PE infection is frequently seen in patients with hepatobiliary cancer (17.4% vs. 4.5%, P = 0.037), leukemia (13.0% vs. 2.6%, P = 0.046), and those with profound neutropenia (defined as absolute neutrophil count < 100) (73.9% vs. 43.6%, P = 0.007) in contrast to those with lung cancer (0% vs. 14.7%, P = 0.048) and other solid cancer (0% vs. 19.2%, P = 0.016). Multivariate logistic regression reveals that profound neutropenia (adjusted OR 3.67; 95% CI 1.372–9.799; P = 0.010) is an independent risk factor for ESBL-PE infection after adjusting age, the presence of solid tumor, and the parameters of sepsis severity scores. ESBL-PE is rare (12.9%) in chemotherapy-induced FN patients with septic shock. Early empirical carbapenem therapy might be considered in chemotherapy-induced FN patients with profound neutropenia.


Chemotherapy-induced febrile neutropenia Septic shock Beta-lactam resistance Enterobacteriaceae infections Multidrug resistance 


Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose or any funding.

Statement of human and animal rights

The institutional review board of Asan medical center approved the registry (study no.: 2015-1253). All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained before data collection.

Supplementary material

11739_2018_2015_MOESM1_ESM.docx (45 kb)
Supplementary material 1 (docx 44 kb)


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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  • Youn-Jung Kim
    • 1
  • Sung Min Jung
    • 1
  • Jihoon Kang
    • 2
  • Seung Mok Ryoo
    • 1
  • Chang Hwan Sohn
    • 1
  • Dong-Woo Seo
    • 1
    • 3
  • Kyoung Soo Lim
    • 1
  • Jin Won Huh
    • 4
  • Sung-Han Kim
    • 5
  • Won Young Kim
    • 1
    Email author return OK on get
  1. 1.Department of Emergency Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  2. 2.Department of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
  3. 3.Department of Biomedical Informatics, School of MedicineUniversity of California San DiegoSan DiegoUSA
  4. 4.Department of Pulmonary and Critical Care Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  5. 5.Department of Infectious Diseases, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

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