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Cancer patients with neutropenic septic shock: etiology and antimicrobial resistance

Korean Journal of Internal Medicine 2020년 35권 4호 p.979 ~ 987
정성민, 김윤정, 유승목, 손창환, 서동우, 임경수, 김원영,
소속 상세정보
정성민 ( Jung Sung-Min ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
김윤정 ( Kim Youn-Jung ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
유승목 ( Ryoo Seung-Mok ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
손창환 ( Sohn Chang-Hwan ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
서동우 ( Seo Dong-Woo ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
임경수 ( Lim Kyoung-Soo ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
김원영 ( Kim Won-Young ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine

Abstract


Background/Aims: Among patients with febrile neutropenia that developed after chemotherapy, high-risk patients, such as those having clinical instability or Multinational Association of Supportive Care in Cancer score of < 21, require hospitalization for intravenous empiric antibiotic therapy. Monotherapy with an anti-pseudomonal ß-lactam agent is recommended. Although many studies reported the microbial etiology of infections and resistant patterns of febrile neutropenia, the patients were not well characterized as having neutropenic septic shock. Therefore, this study aimed to determine the microbial spectrum of infections and resistance patterns of their isolates in patients with chemotherapy-induced neutropenic septic shock.

Methods: Data of adult patients diagnosed with neutropenic septic shock in the emergency department between June 2012 and December 2016 were extracted from a prospectively compiled septic shock registry at a single academic medical center. Thereafter, microbiological studies and antimicrobial susceptibility tests were conducted.

Results: In total, 109 bacteria were found in patients with neutropenic septic shock. Gram-negative bacteria were the predominant causative organisms (84, 77.1%). Moreover, 33 microorganisms (30.3%) were multidrug-resistant (MDR) bacteria with extended-spectrum ß-lactamase-producing Escherichia coli (17, 50%) being the commonest. The most commonly affected sites in patients with MDR bacterial infections were the gastrointestinal tract (45%) and unknown (43.5%). Approximately 48.5% of MDR bacteria were resistant to cefepime but not to piperacillin- tazobactam or carbapenem.

Conclusions: MDR bacteria were prevalent in patients with chemotherapy-induced neutropenic septic shock. Therefore, piperacillin-tazobactam or carbapenem may be considered as empiric antibiotics if MDR bacteria are suspected to be causative agents.

키워드

Neutropenia; Septic shock; Antibiotics; Multidrug resistance; Escherichia coli

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