Bacteremia caused by ESBL-producing enterobacteria may require treatment with a carbapenem. We evaluated the frequency of bacteremia caused ESBL during febrile neutropenia (FN) in patients with a bacteremia by ESBL documented in a previous episode of FN.

In this retrospective study we identified all patients with bacteremia by ESBL-producing enterobacteria during an episode of FN and looked at microbiologic documentation infection in subsequent episodes of FN.

From 2001 to 2020 we recorded 1624 episodes of FN occurring in 1045 patients, with 64 episodes of FN with ESBL bacteremia occurring in 40 patients. Fourteen patients had at least another episode of FN after the documentation of ESBL bacteremia (median of 1 episode per patient, range 1 – 8). Four of the 14 patients (28.6%) had ESBL bacteremia in a subsequent episode of FN. The agents of bacteremia were Escherichia coli in 2 patients, and Enterobacter cloacae and Klebsiella pneumoniae (1 each). The time from the first to the second bacteremia by ESBL was 2 months, 7 months, 9 months and 10 months, respectively. One patient had an episode of FN without bacteremia between the two episodes with ESBL. Two patients received meropenem as empiric antibiotic therapy in the second episode and survived. Two patients received cefepime. One switched to piperacillin-tazobactam and survived. The other developed ESBL bacteremia on day 6 of cefepime, switched to meropenem but died on day 10 of meropenem.

Considering that the initiation of inappropriate empiric antibiotic therapy in FN results in poor outcome, and given the high frequency of recurrence (28.6%) of ESBL (and 1 in 4 deaths), patients who develop a subsequent episode of FN should receive empiric antibiotic therapy with activity against the ESBL identified in the previous episode of FN.