Clinical Outcomes and Microbiological Characteristics of Severe Pneumonia in Cancer Patients: A Prospective Cohort Study

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.