Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria

Table 1 Clinical and demographic characteristics of all patients with mechanical ventilation during the study period (n = 263)

Characteristics, n (%)	Total (n = 263)	VAP (n = 32)	Non-VAP (n = 231)	P value
Age (yr)1	51.9 ± 17.8	49 ± 19.7	52.3 ± 17.5	0.329
Gender- Masculine	137 (52.1)	16 (50)	110 (47.6)	0.800
Body mass index1	26.2 ± 5.6	24.9 ± 4.5	26.4 ± 5.7	0.188
Solid tumor2	188 (68.1)	25 (67.6)	163 (68.2)	0.938
Cervical	21 (7.6)	2 (5.4)	19 (7.9)	0.749
Head and neck	21 (7.6)	3 (8.1)	18 (7.5)	1
Colon-rectum	20 (7.2)	1 (2.7)	19 (7.9)	0.492
Breast	18 (6.5)	2 (5.4)	16 (6.7)	1
Germinal	15 (5.4)	2 (5.4)	13 (5.4)	1
Esophagus-stomach	14 (5.1)	3 (8.1)	11 (4.6)	0.399
Sarcoma	13 (4.7)	2 (5.4)	11 (4.6)	0.688
Ovarian	10 (3.6)	1 (2.7)	9 (3.8)	1
Lung	10 (3.6)	1 (2.7)	9 (3.8)	1
Prostate	9 (3.3)	2 (5.4)	7 (2.9)	0.348
Liver and bile ducts	9 (3.3)	1 (2.7)	8 (3.3)	1
Pancreas	7 (2.5)	1 (2.7)	6 (2.5)	1
Kidney and bladder	5 (1.8)	2 (5.4)	3 (1.3)	0.136
Other	16 (5.8)	2 (5.4)	14 (5.9)	1
Hematological malignancies2	88 (31.9)	12 (32.4)	76 (31.8)	0.938
Lymphoblastic leukemia	26 (9.4)	3 (8.1)	23 (9.6)	1
Myeloid leukemia	12 (4.3)	3 (8.1)	9 (3.8)	0.207
Non-Hodgkin lymphoma	25 (9.1)	2 (5.4)	23 (9.6)	0.548
Hodgkin lymphoma	4 (1.5)	1 (2.7)	3 (1.2)	0.439
Multiple myeloma	14 (5.1)	2 (5.4)	12 (5)	1
Other3	7 (2.5)	1 (2.7)	6 (2.5)	1
Cancer stage
Recent diagnosis	117 (44.5)	11(34.4)	105 (45.4)	0.236
Progression	93 (35.4)	16 (50)	78 (33.8)	0.07
Relapse	30 (11.4)	2 (6.2)	28 (12.1)	0.551
Partial remission	21 (8)	2 (6.2)	19 (8.2)	1
Complete remission	2 (0.7)	1 (3.1)	1 (0.4)	0.228
Chemotherapy within 3 mo	99 (37.6)	16 (50)	83 (35.9)	0.123
Radiotherapy during the previous 6 mo	23 (8.7)	3 (94)	20 (8.7)	0.749
Biologic antineoplastic drugs	22 (8.4)	6 (18.8)	16 (6.9)	0.155
Charlson index	3 (2, 5)	3 (2, 5)	3 (2, 5)	1
Hospital admission within 3-mo period	75 (28.5)	5 (15.6)	70 (30.3)	0.09
Days of recent hospitalization4	7 (4,12)	5 (4,9)	7 (4,12)	0.544
Recent broad antimicrobials	36 (13.7)	1 (3.1)	35 (15.1)	0.09

¹Median ± SD.

²Percentage was obtained from 276 patients because 13 patients had two different neoplasms (5 in VAP group and 8 in Non-VAP).

³Four had myelodysplastic syndrome, three had chronic leukemia.

⁴Median (Interquartile range). VAP: Ventilator-associated pneumonia.

Table 2 Clinical data related with current hospitalization and mechanical ventilation (n = 263)

Characteristic – n (%)	Total (n = 263)	VAP (n = 32)	Non-VAP (n = 231)	P value
Length of hospitalization (d)1	22 (14, 34)	32 (22, 57)	21 (14, 32)	0.0001
Length of ICU stay (d)1	8 (5, 13)	18 (9, 27)	8 (5, 12)	< 0.0001
Causes for MV
Septic shock	91 (34.6)	10 (31.3)	81 (35)	0.843
Post-surgical procedure	42 (16)	8 (25)	34 (14.7)	0.193
Respiratory failure secondary to pneumonia	37 (14)	3 (9.4)	34 (14.7)	0.589
Hypovolemic shock	37 (14)	8 (25)	29 (12.5)	0.09
Neurologic cause	13 (4.9)	0	13 (5.6)	N/A
Lung tumor activity	7 (2.7)	1 (3.1)	6 (2.6)	0.601
Post-CPR	7 (2.7)	1 (3.1)	6 (2.6)	0.601
Acute pulmonary edema	6 (2.3)	0	6 (2.6)	N/A
Malignant central airway obstruction	5 (1.9)	0	5 (2.2)	N/A
Cardiac failure	3 (1.1)	1 (3.1)	2 (0.8)	0.323
Bronchospasm	2 (0.8)	0	2 (0.8)	N/A
Pulmonary embolism	2 (0.8)	0	2 (0.8)	N/A
TRALI	1 (0.4)	0	1 (0.4)	N/A
Other causes	10 (3.8)	0	10 (4.3)	N/A
SOFA at ICU admission2	8.3 ± 3.4	8.7 ± 2.8	8.3 ± 3.4	0.477
Days of mechanical ventilation1	8 (4, 12)	16 (9, 27)	7 (4, 11)	< 0.0001
Tracheostomy	68 (25.9)	19 (59.4)	49 (21.2)	< 0.0001
Re-intubation	27 (10.3)	7 (21.9)	20 (8.7)	0.03
Mortality at 60 d	116 (44.1)	9 (28.1)	72 (31.7)	0.839

¹Median (Interquartile range).

²mean ± SD. CPR: Cardiopulmonary resuscitation; N/A: Not applicable; TRALI: Transfusion-related acute lung injury; ICU: Intensive care unit; SOFA: Sequential Organ Failure Assessment score; MV: Mechanical ventilation; VAP: Ventilator-associated pneumonia.

Table 3 Univariate and multivariate analysis for ventilator-associated pneumonia in patients with mechanical ventilation (n = 263)

Characteristics	Univariate			Multivariate
	NAV (n = 32)	No-NAV (n = 231)	P value	OR	P value
Female	16 (50)	121 (52.4)	0.8	-
Male	16 (50)	110 (47.6)
Age < 60 yr	21 (65.6)	134 (58)	0.411	-
Age ≥ 60 yr	11 (34.4)	97 (42)
Solid tumor	12 (37.5)	76 (32.9)	0.605	-
Hematologic malignancy	20 (62.5)	155 (67.1)
Recent diagnosis, complete or partial remission	14 (43.8)	125 (54.1)	0.271	1	0.541
Progression or relapse	18 (56.2)	106 (45.9)		1.3 (0.55 - 3.03)
Non-recent chemotherapy	16 (50)	148 (64.1)	0.123	1	0.727
Recent chemotherapy	16 (50)	83 (35.9)		1.16 (0.49-2.76)
SOFA at ICU admission	8.71 ± 2.79	8.26 ± 3.42	0.477	-
Days of hospitalization length1	32 (22, 57)	21 (14, 32)	0.0001	1	0.301
				1 (0.99- 1.01)
Days of ICU length1	18 (9, 27)	8 (5, 12)	< 0.0001	1	< 0.0001
				1.11 (1.06-1.17)
Alive	10 (31.2)	122 (52.8)	0.02	1	0.125
Death	22 (68.8)	109 (47.2)		2.04 (0.82-5.12)

¹Median (Interquartile range). ICU: Intensive care unit.

Table 4 Use of antimicrobials in patients with ventilator-associated pneumonia vs those who did not develop the latter

Antimicrobial treatment	Total (n = 263)	Non-VAP (n = 233)	VAP (n = 30)	P value
Antibacterial treatment
Cephalosporins	58 (22)	47 (20.2)	11 (36.7)	0.03
Days of cephalosporins12	6 (4, 9)	6 (4, 9)	4 (4, 10)	0.856
TZP	86 (32.6)	69 (29.6)	17 (56.7)	0.002
Days of TZP2	6 (4, 9)	7 (4, 9)	6 (5, 7)	0.895
Aminoglycosides	18 (6.8)	14 (6)	4 (13.3)	0.134
Days of aminoglycosides2	4 (3, 6)	3 (3, 5)	5 (4, 7)	0.469
Carbapenem	228 (86.7)	198 (85)	30 (100)	0.02
Days of Carbapenem2	11 (7, 17)	10 (6, 16)	13 (10, 22)	0.003
Fluoroquinolones	31 (11.8)	23 (9.9)	8 (26.7)	0.006
Days of fluoroquinolones2	10 (7, 14)	11 (7, 14)	9 (5, 15)	0.586
Vancomycin	153 (58.2)	130 (55.8)	24 (80)	0.01
Days of vancomycin2	7 (4, 10)	7 (4, 10)	7 (4, 10)	0.684
Linezolid	47 (17.8)	39 (16.7)	8 (26.7)	0.205
Days of linezolid2	9 (5, 12)	8 (4, 11)	14 (8, 21)	0.05
Clarithromycin	68 (25.8)	59 (25.3)	9 (30)	0.657
Days of clarithromycin2	8 (7, 10)	8 (6, 10)	8 (8,10)	0.505
SMX/TMP	68 (25.8)	56 (24)	12 (40)	0.06
Days of SMX/TMP2	8 (5, 13)	12 (7, 21)	12 (8, 14)	0.577
Colistin	11 (4.2)	7 (3)	4 (13.3)	0.02
Days of colistin2	10 (4, 11)	8 (3, 11)	11 (8, 12)	0.341

¹Third-generation.

²Median (Interquartile range). TZP: Piperacillin/tazobactam; VAP: Ventilator-associated pneumonia.

Table 5 Univariate and multivariate analysis for 60-d mortality in patients with mechanical ventilation (n = 263)

Characteristics	Univariate			Multivariate
	Alive (n = 147)	Death (n = 116)	P value	OR	P value
Female	79 (53.7)	58 (50)	0.546	-
Male	68 (46.3)	58 (50)
Age < 60 yr	83 (56.5)	72 (62.1)	0.358	-
Age ≥ 60 yr	64 (43.5)	44 (37.9)
Solid tumor	101 (68.7)	74 (63.8)	0.401	-
Hematologic malignancy	46 (31.3)	42 (36.2)
Recent diagnosis, complete or partial remission	85 (57.8)	54 (46.6)	0.069	1	0.237
Progression or relapse	62 (42.2)	62 (53.4)		1.38 (0.81-2.37)
Non-recent chemotherapy	103 (70.1)	61 (52.6)	0.003	1	0.006
Recent chemotherapy	44 (29.9)	55 (47.4)		2.16 (1.24-3.76)
SOFA at ICU admission	8.45 ± 3.45	8.15 ± 3.2	0.471	-
Non-tracheostomy	115 (78.2)	80 (69)	0.088	1	0.01
Required tracheostomy	32 (21.8)	36 (31)		2.52 (1.24-5.13)
Days of ICU length	8 (6, 13)	8 (5, 15)	0.457	-
Days of mechanical ventilation	7 (4, 11)	9 (5, 14)	0.029	1	0.15
				1.04 (1.008-1.07)
Non-VAP	132 (89.8)	99 (85.3)	0.342	-
VAP	15 (10.2)	17 (14.7)

ICU: Intensive care unit; SOFA: Sequential Organ Failure Assessment score; VAP: Ventilator-acquired pneumonia.