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
ARTICLE HIGHLIGHTS
Research 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).

Research motivation

To establish and/or modify guidelines for the initiation of empirical antimicrobial treatment in cancer patients who develop VAP.

Research objectives

To describe in the patient with cancer which are the risk factors for developing ventilator-acquired pneumonia, and if there is a higher incidence of episodes secondary to multidrug-resistant bacteria.

Research methods

A retrospective study carried out over a two-year period, that included all patients with mechanical ventilation who were admitted to the ICU, and we analyzed those who developed an episode of VAP and the bacteria involved.

Research results

Two hundred sixty-three patients were included; two thirds with a solid tumor. There were 32 episodes of VAP; 11.5 episodes/1000 ventilation-days. Gram-negative bacteria were involved in 95%of cases, 24% were MDRB. There were no differences in mortality between those patients with VAP vs non-VAP, neither when MDRB vs non-MDRB were compared. Length of ICU was documented as risk factor for VAP. Recent chemotherapy and tracheostomy were predictive risk factors for 60-d mortality.

Research conclusions

The rate of VAP was similar to that reported in other studies. We described an elevated percentage of Gram-negative bacteria as a cause of pneumonia, which permits beginning empiric antibiotic coverage for these pathogens. MDRB were found in a quarter of the episodes, and were not linked to increased mortality at 60 d.

Research perspectives

To perform a monitoring for a longer period of time will allow evaluating the evolution of bacterial resistance, and establishing whether, with a greater number of cases, it can impact the mortality of these patients.