Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Aug 7, 2020; 9(3): 43-53
Published online Aug 7, 2020. doi: 10.5492/wjccm.v9.i3.43
Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria
Patricia Cornejo-Juárez, Ivan González-Oros, Paola Mota-Castañeda, Diana Vilar-Compte, Patricia Volkow-Fernández
Patricia Cornejo-Juárez, Ivan González-Oros, Paola Mota-Castañeda, Diana Vilar-Compte, Patricia Volkow-Fernández, Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
Author contributions: Cornejo-Juárez P designed, made the analysis and wrote the paper; González-Oros I and Mota-Catañeda P performed the research; Vilar-Compte D and Volkow-Fernández P supervised the report and made intellectual contributions.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Instituto Nacional de Cancerología (2019/0096).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data and the confidentiality of the patients was preserved.
Conflict-of-interest statement: All the authors declare do not have conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Patricia Cornejo-Juárez, MD, MSc, Assistant Professor, Chief Doctor, Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Del. Tlalpan, Mexico City 14080, Mexico. patcornejo@yahoo.com
Received: December 16, 2019
Peer-review started: December 16, 2019
First decision: April 2, 2020
Revised: May 22, 2020
Accepted: June 14, 2020
Article in press: June 14, 2020
Published online: August 7, 2020
Processing time: 233 Days and 13.4 Hours
Abstract
BACKGROUND

Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation (MV). The emergence of multidrug resistant bacteria (MDRB) has become a public health problem, creating a new burden on medical care in hospitals, particularly for patients admitted to the intensive care unit (ICU).

AIM

To describe risk factors for ventilator-acquired pneumonia (VAP) in patients with cancer and to evaluate the impact of MDRB.

METHODS

A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City, which included all patients who were admitted to the ICU and required MV ≥ 48 h. They were classified as those who developed VAP versus those who did not; pathogens isolated, including MDRB. Clinical evolution at 60-d was assessed. Descriptive analysis was carried out; comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB.

RESULTS

Two hundred sixty-three patients were included in the study; mean age was 51.9 years; 52.1% were male; 68.4% had solid tumors. There were 32 episodes of VAP with a rate of 12.2%; 11.5 episodes/1000 ventilation-days. The most frequent bacteria isolated were the following: Klebsiella spp. [n = 9, four were Extended-Spectrum Beta-Lactamase (ESBL) producers, one was Carbapenem-resistant (CR)]; Escherichia coli (n = 5, one was ESBL), and Pseudomonas aeruginosa (n = 8, two were CR). One Methicillin-susceptible Staphylococcus aureus was identified. In multivariate analysis, the sole risk factor associated for VAP was length of ICU stay (OR = 1.1; 95%CI: 1.03-1.17; P = 0.003). Sixty-day mortality was 53% in VAP and 43% without VAP (P = 0.342). There was not higher mortality in those patients with MDRB.

CONCLUSION

This study highlights the high percentage of Gram-negative bacteria, which allows the initiation of empiric antibiotic coverage for these pathogens. In this retrospective, single center, observational study, MDRB VAP was not directly linked to increased mortality at 60 days.

Keywords: Ventilator-associated pneumonia; Cancer; Multidrug resistance bacteria; Mortality; Intensive care unit; Mechanical ventilation

Core tip: This is a retrospective study to evaluate the risk factors for ventilator-associated pneumoniae (VAP) in patients with cancer who are admitted at an intensive care unit and require mechanical ventilation for > 48 h. We emphasized in microbiology etiology, particularly multidrug resistant bacteria (MDRB). We included 263 patients during 2 year-period; 32 developed VAP, with a rate of 11.5 episodes/1000 ventilation-days. Gram-negative bacteria were isolated in 95% of cases, being the rate of MDRB 24.1%. Sixty-day mortality was 53% in VAP and 43% without VAP. There was not higher mortality in patients with MDRB.