Treatment of nosocomial postoperative pneumonia in cancer patients: A prospective randomized study

Background: Nosocomial pneumonia continues to be associated with high morbidity and mortality in cancer patients. Methods: In an attempt to find an optimal treatment for this infection, nonneutropenic cancer patients with postoperative nosocomial pneumonia were randomized to receive either piperacillin/ tazobactam (P/T) 4.5 g IV every 6 hours (30 patients) or clindamycin (Cl) 900 mg plus aztreonam (Az) 2 g IV every 8 hours (22 patients). Amikacin 500 mg IV every 12 hours was given to all patients for the first 48 hours. Results: The two groups were comparable for the characteristics of pneumonia that included Cram-negative etiology and duration of intubation. Response rates were 83% for patients who received P/T and 86% for those who received Cl/Az (P > .99). There were no serious adverse events; however, at our center the cost of the P/T regimen was $73.86 compared with $99.15 for the Cl/Az regimen. Conclusions: The two regimens had comparable high efficacy, and P/T had a slight cost advantage. Either of these antibiotic regimens combined with an aminoglycoside could lead to favorable outcome in cancer patients at high risk for nosocomial pneumonia.