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

PLoS One. 2015 Mar 24;10(3):e0120544. doi: 10.1371/journal.pone.0120544. eCollection 2015.

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 microbiological characteristics 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Critical Illness
  • Gram-Negative Bacterial Infections / complications*
  • Gram-Negative Bacterial Infections / microbiology
  • Gram-Negative Bacterial Infections / mortality
  • Gram-Negative Bacterial Infections / therapy*
  • Hospital Mortality
  • Humans
  • Intensive Care Units
  • Length of Stay
  • Middle Aged
  • Mortality
  • Neoplasms / complications*
  • Neoplasms / microbiology
  • Neoplasms / mortality
  • Pneumonia / complications*
  • Pneumonia / microbiology
  • Pneumonia / mortality
  • Pneumonia / therapy*
  • Prospective Studies
  • Pseudomonas aeruginosa / isolation & purification
  • Respiration, Artificial
  • Shock, Septic / complications
  • Shock, Septic / microbiology
  • Shock, Septic / mortality
  • Shock, Septic / therapy
  • Staphylococcus aureus / isolation & purification
  • Streptococcus pneumoniae / isolation & purification
  • Survival Analysis
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents

Grants and funding

The present work was supported by grants from the National Council for Scientific and Technological Development (CNPq), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) and departmental funds from the Instituto Nacional de Câncer. Jorge Salluh is an academic editor of this Journal. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.