Abstract

Pneumonia is frequently encountered in immunosuppressed patients and its mortality is very high. This study was planned to evaluate the incidence, the diagnosis and the outcomes of empirical antimicrobial therapy for pneumonia developing in patients with hematological malignancies (HM).

The charts of the 342 patients (83 NHL, 66 HL, 54 AML, 23 CML, 23 ALL, 51 CLL, 42 MM) who were on follow-up in the hematology clinic between 1997 and 2000 were reviewed retrospectively. 26 (7.6%) of these patients who also had pneumonia were included in the study.

The mean of the patients’ ages was 41.23±19.35 years (16 men,10 women) and the mean duration of illness was 19.40±24.30 months. Pneumonia was most frequently detected in patients with ALL (39.1%). In 11 (42%) of the cases, it was diagnosed as community-acquired pneumonia (CAP) and in 15 (58%) of them as hospital-acquired pneumonia (HAP), respectively. The mean neutrophil count was 262.50±15.59/mm3 in 9 (34.6%) neutropenic patients. 8 of the patients with HAP had neutropenia, though only one with CAP was neutropenic. The most commonly encountered radiological sign was lobar infiltration, observed in 16 patients out of 26 (61.5%). Blood and sputum cultures revealed coagulase (-) staphylococcus in 4 cases, group A b hemolytic streptococcus in 2 cases and Klebsiella pneumoniae in one case. The most commonly used antimicrobials were sulbactam-ampicillin in CAP patients, carbapenem plus an aminoglycoside in nonneutropenic HAP patients or carbapenem plus an aminoglycoside plus a glycopeptid plus an antifungal in neutropenic HAP patients. The mean duration of antimicrobial agent use was 18.88±18.48 days. In total, 5 patients (19.2%), 3 of whom had febrile neutropenia died due to pneumonia.

With respect to the results of our study, pneumonia is a frequently encountered infection in patients with HM, primarily with ALL, and has a high mortality. We think that a broad spectrum ampirical treatment should be started early.