Necrotizing Pneumonia in Cancer Patients. Issue 2 (March 2015)

• Record Type: Journal Article
• Authors: Yacoub, Abraham Tareq; Halliday, Joseph; Katayama, Mitusya; Pasikhova, Yanina; Katzman, Adam; Ralys, Alexander; Sandin, Ramon L.; Greene, John
• Is Part Of: Infectious diseases in clinical practice. Volume 23:Issue 2(2015:Mar.)
• Publication Date: 2015-03
• Subjects: Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Periodicals; Electronic journals; 616.9
• DOI: 10.1097/IPC.0000000000000206
• Languages: English
• ISSNs: 1056-9103

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background</title> <p>Necrotizing pneumonia (NP) is a rare, pathologic process similar to lung abscess defined by multiple, small (<2 cm) cavitary lesions that has a variety of causes. Risk factors include potential for aspiration, frequent or prolonged hospitalization, and immunosuppression. Common pathogens include staphylococcus, streptococcus, anaerobes, aerobic gram-negative bacilli, mycobacteria, <italic>Nocardia</italic>, and fungi. The purpose of our study was to characterize the causes of NP in cancer patients and to appreciate the different etiologies when hematologic malignancy (HM) patients are compared with solid tumor patients because of differences in immunosuppression.</p> </sec> <sec> <title>Methods</title> <p>Our study entailed a retrospective chart review conducted at the Moffitt Cancer Center in Tampa, Fla, within the past 24 years (January 1, 1987, to June 1, 2011) between the ages of 18 and 85 years diagnosed with NP. The patients were identified through review of our institutional databases. Patients were initially screened through visual review of computed tomography scans for cavitary lesions and then confirmed via radiology reports demonstrating an NP or lung abscess and by clinical notes. Patients without a primary lung infectious microorganism confirmed by reliable culture were placed into 2 groups based on presentation and speed of cavitation from the onset of symptoms, with 7 days being the cutoff. Neutropenia was defined as an absolute neutrophil count of less than 500/μL. Small versus large cavitary lesions were distinguished by a cutoff of 2 cm. For demographic, descriptive and clinical data, standard descriptive statistics were used. For comparisons between groups involving nominal data, χ<sup>2</sup> tests were used. One-way analysis of variance tests were performed for comparisons between multiple groups with numerical data. <italic>P</italic> < 0.05 was considered statistically significant where appropriate.</p> </sec> <sec> <title>Results</title> <p>We identified 65 cases of NP, with 44 (68%) having positive cultures for 1 or more organisms. Methicillin-resistant <italic>Staphylococcus aureus</italic>, <italic>Pseudomonas aeruginosa</italic>, <italic>Klebsiella</italic> species, mycobacteria, streptococci, and other unidentified fast-growing organisms were more common in lung cancer and obstructive lung disease compared with HM (9.1% vs 3.0%, 18.2% vs 6.1%, 4.5% vs 3.0%, 13.6% vs 0%, 9.1% vs 0%, and 13.6% vs 12.1%, respectively). Conversely, <italic>Aspergillus</italic>, <italic>Nocardia</italic>, unidentified slow-growing organisms, and other rare organisms were more common in HM (15.2% vs 13.6%, 6.1% vs 4.5%, 24.2% vs 4.5%, and 21.2% vs 13.6%, respectively). Neutropenia at the time of diagnosis was observed in 15 patients with HM (45%), 1 patient with nonlung solid organ cancer (9%), and none of the patients with lung cancer. Hematologic malignancy had significantly more deaths due to respiratory failure and other causes (18% and 12%, respectively) compared with lung disease (5% and 0%, respectively). The association between infecting organism and speed of progression to NP was not significant (<italic>P</italic> = 0.11).</p> </sec> <sec> <title>Conclusions</title> <p>We found that HM patients with NP had a higher mortality and more opportunistic and slow-growing organisms when compared with cancer patients with lung disease or other solid tumors. Further study is needed to determine the role that neutropenia, duration of illness, and isolated pathogen play in the treatment of cancer patients with NP.</p> </sec> </abstract>