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Purpose <p>Patients with active lung or lower head and neck cancer (HNC) are at increased risk of infection, particularly hospital-acquired pneumonia (HAP), ventilated HAP (vHAP) and ventilator-associated pneumonia (VAP), due to immunosuppression and treatment-related side effects. These infections are associated with increased mortality, prolonged hospital stays and interruptions in cancer therapy. Despite their clinical relevance, data on epidemiology, risk factors, treatment, and outcomes in this population remain limited.</p> Methods <p>We conducted a retrospective, observational, multicentre matched cohort study at eight tertiary care centres in Germany and Spain. Patients with lung or lower HNC who received anti-cancer treatment between January 2018 and May 2022 and were hospitalised for at least 48&#xa0;h were included. Patients with HAP/vHAP/VAP (case group) were matched 1:1 to those without pneumonia (control group) and followed for 90 days.</p> Results <p>A total of 256 patients were included, with median ages of 65 (cases) and 64 years (controls). Most patients had lung cancer (94%, <i>n</i> = 240), predominantly in stages III-IV (81%, <i>n</i> = 207). In the case group, patients had mostly HAP (88%, <i>n</i> = 113), diagnosed in median 7 days after hospital admission. Common antibiotics given included penicillin derivatives with β-lactamase inhibitors, cephalosporins and carbapenems. Patients with HAP/vHAP/VAP had significantly higher mortality and longer hospital stays (<i>p</i> &lt; 0.001). Cox regression identified HAP/vHAP/VAP and dysphagia as independent predictors of mortality.</p> Conclusion <p>HAP/vHAP/VAP imposes a significant clinical burden in patients with lung or lower HNC. Early prevention, timely diagnosis, and close monitoring of high-risk patients are essential to improve outcomes.</p>

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Prognosis and aetiology of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in patients with active lung or lower head and neck cancer (PEPP-C): a retrospective, matched multicentre cohort study in Germany and Spain

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  • 发表日期：

    2026年5月4日

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  • Sina M. Pütz,
  • Marie Engelhard,
  • Sebastian M. Wingen-Heimann,
  • David F. Brilz,
  • Brune Akrich,
  • Heike Kohl,
  • Annika Y. Classen,
  • Carlota Gudiol,
  • Enric Sastre-Escola,
  • Franziska C. Trudzinski,
  • Arturo Olivares Rivera,
  • Eva Lücke,
  • Tadeusz Marczewski,
  • Ayham Daher,
  • Stephan Eisenmann,
  • Jacqueline Schmitz,
  • Anke Reinacher-Schick,
  • Julia von Tresckow,
  • Rebekka Mispelbaum,
  • Tessa Hattenhauer,
  • J. Janne Vehreschild

摘要

Purpose

Patients with active lung or lower head and neck cancer (HNC) are at increased risk of infection, particularly hospital-acquired pneumonia (HAP), ventilated HAP (vHAP) and ventilator-associated pneumonia (VAP), due to immunosuppression and treatment-related side effects. These infections are associated with increased mortality, prolonged hospital stays and interruptions in cancer therapy. Despite their clinical relevance, data on epidemiology, risk factors, treatment, and outcomes in this population remain limited.

Methods

We conducted a retrospective, observational, multicentre matched cohort study at eight tertiary care centres in Germany and Spain. Patients with lung or lower HNC who received anti-cancer treatment between January 2018 and May 2022 and were hospitalised for at least 48 h were included. Patients with HAP/vHAP/VAP (case group) were matched 1:1 to those without pneumonia (control group) and followed for 90 days.

Results

A total of 256 patients were included, with median ages of 65 (cases) and 64 years (controls). Most patients had lung cancer (94%, n = 240), predominantly in stages III-IV (81%, n = 207). In the case group, patients had mostly HAP (88%, n = 113), diagnosed in median 7 days after hospital admission. Common antibiotics given included penicillin derivatives with β-lactamase inhibitors, cephalosporins and carbapenems. Patients with HAP/vHAP/VAP had significantly higher mortality and longer hospital stays (p < 0.001). Cox regression identified HAP/vHAP/VAP and dysphagia as independent predictors of mortality.

Conclusion

HAP/vHAP/VAP imposes a significant clinical burden in patients with lung or lower HNC. Early prevention, timely diagnosis, and close monitoring of high-risk patients are essential to improve outcomes.