Insights on the Extremely High Mortality of Ventilator Associated Pneumonia in Cancer Patients

Abstract

BackgroundPatients with cancer are at high risk of infections and subsequent complications. Due to the high prevalence of multidrug resistant pathogens in ventilator associated pneumonia (VAP) in those patients, most studies and guidelines exclude this population in their analysis. In the present study, we sought to investigate the clinical and laboratory presentation, as well as prognosis of cancer patients diagnosed with VAP in a large tertiary care center in Brazil.MethodsWe included all cancer patients admitted to the intensive care unit who were diagnosed with culture positive VAP matching the CDC diagnostic criteria from 2013 to 2016. We collected a detailed clinical, laboratory and microbiological profile of those individuals. Additionally, all patients were followed for 30-day all-cause mortality.ResultsA total of 25 individuals (mean age 58 ± 14 years, 88% males) were included. Among them, 88% presented with solid tumors and 12% with hematologic cancers. The median length of stay at the hospital prior to VAP diagnosis was 30 days (interquartile range (IQR): 13 - 39), with a median duration of ICU admission of 16 days (IQR: 8 – 23) and a median mechanical ventilation duration of 12 days (IQR: 8 – 16). The most common causative agents for VAP were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa with seven cases (28%) each, followed by Staphylococcus aureus and Stenotrophomonas maltophilia with two cases (8%) each. From the 21 gram-negative bacteria 20 (90%) were carbapenem-resistant, 5 (24%) were colistin- resistant, while all S. aureus were MRSA. The 30-day mortality rate was 84% (21/25 individuals). The mortality was high across the spectrum of clinical and laboratory presentations, and none of the clinical predictors evaluated, including age, gender, diabetes, smoking, radiotherapy, chemotherapy, post-surgery, reintubation, dialysis, or antibiotic susceptibility, was associated with lower mortality.ConclusionVentilator associated Pneumonia in cancer patients has an extremely high 30-day mortality (88%), with a low in vitro susceptibility for broad spectrum antibiotics, such as carbapenems. No clinical predictors are independently associated with lower mortality.Disclosures All authors: No reported disclosures.