title: Clinical outcomes and microbiological characteristics of severe pneumonia in cancer patients: a prospective cohort study.
abstract: BACKGROUND
  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.
authors: Postgraduate Program of Internal Medicine - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors: Ligia S C F
authors: LS
authors: Rabello
authors: Postgraduate Program of Internal Medicine - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors: Jose R L
authors: JR
authors: Silva
authors: Intensive Care Unit, Hospital Sirio-Libanes, São Paulo, Brazil.
authors: Luciano C P
authors: LC
authors: Azevedo
authors: Intensive Care Unit, Hospital Sirio-Libanes, São Paulo, Brazil.
authors: Ivens
authors: I
authors: Souza
authors: Postgraduate Program of Internal Medicine - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors: Viviane B L
authors: VB
authors: Torres
authors: Intensive Care Unit, Hospital Barra Dor, Rio de Janeiro, Brazil.
authors: Maíra M
authors: MM
authors: Rosolem
authors: Intensive Care Unit, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.
authors: Thiago
authors: T
authors: Lisboa
authors: Postgraduate Program of Internal Medicine - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors: Marcio
authors: M
authors: Soares
authors: Postgraduate Program of Internal Medicine - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors: Jorge I F
authors: JI
authors: Salluh
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016638:Critical Illness; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D011014:Pneumonia / Q000150:complications* / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents