Departments of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Oncologist. 2020 May;25(5):e861-e869. doi: 10.1634/theoncologist.2019-0031. Epub 2020 Feb 11.
Data on the incidence, etiology, and prognosis of non-ventilator-associated pneumonia in hospitalized patients with solid tumors are scarce. We aimed to study the characteristics of non-ventilator-associated pneumonia in hospitalized patients with solid tumors.
This was a prospective noninterventional cohort study of pneumonia in patients hospitalized in an oncology ward in a tertiary teaching hospital. Pneumonia was defined according to the American Thoracic Society criteria. Patients were followed for 1 month after diagnosis or until discharge. Survivors were compared with nonsurvivors.
A total of 132 episodes of pneumonia were diagnosed over 1 year (9.8% of admissions to the oncology ward). They were health care-related (67.4%) or hospital-acquired pneumonia (31.8%). Lung cancer was the most common malignancy. An etiology was established in 48/132 episodes (36.4%). Knowing the etiology led to changes in antimicrobial therapy in 58.3%. Subsequent intensive care unit admission was required in 10.6% and was linked to inappropriate empirical therapy. Ten-day mortality was 24.2% and was significantly associated with hypoxia (odds ratio [OR], 2.1). Thirty-day mortality was 46.2%. The independent risk factors for 30-day mortality were hypoxia (OR, 3.3), hospital acquisition (OR, 3.1), and a performance status >1 (OR, 2.6). Only 40% of patients who died within 30 days were terminally ill.
Pneumonia is a highly prevalent condition in hospitalized patients with solid tumors, even with nonterminal disease. Etiology is diverse, and poor outcome is linked to inappropriate empirical therapy. Efforts to get the empirical therapy right and reach an etiological diagnosis to subsequently de-escalate are warranted.
The present study shows that pneumonia is a prevalent infectious complication in patients admitted to oncology wards, with a very high mortality, even in non-terminally ill patients. Etiology is diverse, and etiological diagnosis is reached in fewer than 40% of cases in nonintubated patients. Intensive care unit admission, a marker of poor outcome, is associated with inappropriate empirical therapy. These results suggest that, to improve prognosis, a more precise and appropriate antimicrobial empirical therapy for pneumonia in patients with solid tumors is necessary, together with an effort to reach an etiological diagnosis to facilitate subsequent de-escalation.
关于住院实体瘤患者中非呼吸机相关性肺炎的发病率、病因和预后的数据很少。我们旨在研究住院实体瘤患者中非呼吸机相关性肺炎的特征。
这是一项对三级教学医院肿瘤科住院患者肺炎的前瞻性非干预性队列研究。肺炎根据美国胸科学会标准定义。诊断后或直至出院后 1 个月对患者进行随访。幸存者与非幸存者进行比较。
在 1 年内共诊断出 132 例肺炎（肿瘤科住院患者的 9.8%）。它们是与医疗保健相关的（67.4%）或医院获得性肺炎（31.8%）。肺癌是最常见的恶性肿瘤。在 132 例肺炎中确定病因的有 48 例（36.4%）。了解病因可导致 58.3%的抗菌治疗发生变化。10.6%的患者需要后续进入重症监护病房，这与经验性治疗不当有关。10 天死亡率为 24.2%，与缺氧显著相关（比值比[OR]，2.1）。30 天死亡率为 46.2%。30 天死亡率的独立危险因素为缺氧（OR，3.3）、医院获得性肺炎（OR，3.1）和体能状态>1（OR，2.6）。仅 40%的 30 天内死亡患者为终末期疾病。
肺炎在住院实体瘤患者中是一种高发疾病，即使是非终末期疾病也是如此。病因多种多样，不良预后与经验性治疗不当有关。努力使经验性治疗正确并进行病因诊断以随后降级是合理的。
本研究表明，肺炎是肿瘤科住院患者中常见的感染性并发症，即使在非终末期患者中，死亡率也非常高。病因多种多样，在非插管患者中，不到 40%的病例可明确病因诊断。重症监护病房入院是预后不良的标志，与经验性治疗不当有关。这些结果表明，为了改善预后，需要对实体瘤患者的肺炎进行更精确和适当的抗菌经验性治疗，并努力进行病因诊断，以促进随后的降级。
