Pulmonary infections in an acute palliative care unit

Pulmonary infections in patients with advanced cancer represent a clinical challenge, often requiring a delicate balance between aggressive treatment and comfort-oriented care. In acute palliative care units (APCUs), these decisions are further compressed by high clinical acuity and rapid transitions.

To describe the prevalence, diagnostic patterns, therapeutic interventions, and clinical outcomes of patients diagnosed with pneumonia in a dedicated APCU.

We conducted a retrospective observational study of consecutive admissions to an APCU in Italy over a 1-year period (2024). Data on demographics, functional status, diagnostic work-up, antimicrobial therapy, and discharge outcomes were collected.

Out of 550 admissions, 22 patients were diagnosed with pneumonia (4.0%). The cohort was characterized by high frailty (mean KPS 44.1). All patients underwent CT scans for diagnosis and received antibiotic therapy, most frequently piperacillin/tazobactam (54.5%) and meropenem (36.4%). Clinical resolution was achieved in 80% of evaluable cases. The majority of patients were successfully discharged home or to community-based palliative care (72.7%), with an APCU mortality rate of 9.1%. Dyspnea at admission was a mean ESAS score of 3.21 (SD 2.35), and no significant changes were observed at the time of clinical resolution or discharge (p = 0.396). Oxygen therapy was required by 31.8% of patients at admission and 27.3% at discharge.

Pneumonia in the APCU setting is managed with high diagnostic and therapeutic intensity. This "active" approach appears to facilitate clinical stabilization and successful discharge, suggesting that intensive antimicrobial treatment can be consistent with palliative goals in specialized acute units.