Clinical outcomes and microbiological characteristics of severe pneumonia in cancer patients: A prospective cohort study

  • L.S.C.F. Silva and L.C.P., Azevedo and I., Souza and V.B.L., Torres and M.M., Rosolem and T., Lisboa and M., Soares R
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Abstract

Introduction Pneumonia is the most frequent type of infection in cancer patients and a frequent cause of ICU admission. The primary aims of this study were to describe the clinical and microbiologicalcharacteristics and outcomes in critically ill cancer patients with severe pneumonia. Methods Prospective cohort study in 325 adult cancer patients admitted to three ICUs with severe pneumonia not acquired in the hospital setting. Demographic, clinical and microbiological data were collected. Results There were 229 (71%) patients with solid tumors and 96 (29%) patients with hematological malignancies. 75% of all patients were in septic shock and 81% needed invasive mechanical ventilation. ICU and hospital mortality rates were 45.8%and 64.9%. Microbiological confirmation was present in 169 (52%) with a predominance of Gram negative bacteria [99 (58.6%)]. The most frequent pathogens were methicillin-sensitive S. aureus [42 (24.9%)], P. aeruginosa [41(24.3%)] and S. pneumonia [21 (12.4%)]. A relatively low incidence of MR [23 (13.6%)] was observed. Adequate antibiotics were prescribed for most patients [136 (80.5%)]. In multivariate analysis, septic shock at ICU admission [OR 5.52 (1.92-15.84)], the use of invasive MV [OR 12.74 (3.60-45.07)] and poor Performance Status [OR 3.00 (1.07-8.42)] were associated with increased hospital mortality. Conclusions Severe pneumonia is associated with high mortality rates in cancer patients. A relatively low rate of MR pathogens is observed and severity of illness and organ dysfunction seems to be the best predictors of outcome in this population. Copyright © 2015 Rabello et al.

Author-supplied keywords

  • *cancer patient
  • *cohort analysis
  • *human
  • *microbiological examination
  • *outcome assessment
  • *pneumonia
  • *prognosis
  • Cohort Studies
  • Gram negative bacterium
  • Gram negative infection
  • Hospital Mortality
  • Pneumonia
  • Pseudomonas aeruginosa
  • Streptococcus pneumoniae
  • adult
  • aged
  • antibiotic agent
  • antibiotic resistance
  • antibiotic therapy
  • article
  • artificial ventilation
  • clinical feature
  • cohort analysis
  • community acquired pneumonia
  • critically ill patient
  • demography
  • disease association
  • disease classification
  • disease severity
  • diseases
  • female
  • functional status assessment
  • healthcare associated infection
  • hematologic malignancy
  • hospital
  • hospital admission
  • human
  • incidence
  • infection
  • intensive care unit
  • major clinical study
  • male
  • methicillin susceptible Staphylococcus aureus
  • meticillin
  • mortality
  • multivariate analysis
  • nuclear magnetic resonance
  • pathogenesis
  • patient
  • population
  • prescription
  • prospective study
  • septic shock
  • solid tumor

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Authors

  • Rabello and J R L L.S.C.F. Silva and L.C.P., Azevedo and I., Souza and V.B.L., Torres and M.M., Rosolem and T., Lisboa and M., Soares

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