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Causes, Empirical Antibiotic Therapy, and Outcome

Jordi Carratalà, MD, PhD; Beatriz Rosón, MD; Alberto Fernández-Sevilla, MD, PhD; Fernando Alcaide, MD; Francesc Gudiol, MD, PhD

Arch Intern Med. 1998;158:868-872.

Background  Bacteremic pneumonia is a major cause of death among neutropenic patients with cancer.

Methods  We analyzed the causes, empirical antibiotic therapy, and outcome of 40 consecutive cases of bacteremic pneumonia identified among 408 episodes of bacteremia in adult neutropenic patients with cancer, prospectively documented from 1986 to 1995.

Results  The most frequent causative organisms were Pseudomonas aeruginosa (17 cases), Streptococcus pneumoniae (12 cases), Escherichia coli (5 cases), and Streptococcus mitis (3 cases). Overall, P aeruginosa and S pneumoniae caused 72.5% of all episodes of bacteremic pneumonia, compared with 11.4% of bacteremic episodes from other sources (P<.001). Thirty patients received ceftazidime and 10 patients received imipenem as the -lactam component of the initial empirical treatment. All strains of P aeruginosa were susceptible to both agents. Forty-seven percent of streptococcal strains were penicillin resistant and showed a decreased susceptibility to ceftazidime (minimum inhibitory concentration ranged from 1 to 64 µg/mL). Five patients (12.5%) were considered to have received inappropriate empirical antibiotic therapy. Attributable mortality in patients with bacteremic pneumonia was higher than in patients with bacteremia from other sources; 22 (55%) of the 40 patients with bacteremic pneumonia died, whereas 39 (10.6%) of the 368 patients with bacteremia from other sources died (P<.001).

Conclusions  Our data suggest that bacteremic pneumonia in neutropenic cancer patients is associated with a poor outcome and that empirical antibiotic therapy for neutropenic patients with pneumonia should include agents active against both P aeruginosa and cephalosporin-resistant streptococci.

From the Services of Infectious Disease (Drs Carratalà, Rosón, and Gudiol), Hematology (Dr Fernández-Sevilla), and Microbiology (Dr Alcaide), Ciutat Sanitària i Universitària de Bellvitge, University of Barcelona, Barcelona, Spain.

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