A Retrospective Review of the Frequency of Infections and Patterns of Antibiotic Utilization on a Palliative Care Unit

Abstract

Various disease-related and therapy-induced factors make cancer patients susceptible to infections. The epidemiology and management of infections in neutropenic cancer patients and patients with primary hematological malignancies has been widely reported, but very few studies have characterized infections and their management in palliative care patients. We conducted a retrospective review of 100 consecutive admissions to an acute palliative care unit with the objective of assessing overall and site-specific frequencies of infections, the pathogens involved and their antibiotics sensitivities, and the pattern of antibiotic utilization. The mean age was 64 +/- 11.5 years, the mean length of stay was 29.8 +/- 28.2 days, and 70% of patients died on the unit. Only one case of neutropenia was identified. Fifty-five of the 100 patients were diagnosed with a total of 74 separate infections. The most frequent sites of infections were the urinary tract (39.2%), the respiratory tract (36.5%), skin and subcutaneous tissues (12.2%), and blood (5.4%). Fifty-four culture-positive infections were identified. Overall, the most common organisms were Escherichia coli (22.9%), Staphylococcus aureus (20%), and Enterococcus (11.4%). Fifty-three of the 74 (71.6%) infections were treated with antibiotics. The decision-making process regarding treatment versus nontreatment of an infection can be complex in terminally ill patients and needs to be individualized. Symptom control is the primary objective in the majority of cases. The appropriate management of infections, with specific attention to measures that would improve patients' quality of life, should be a research priority in patients with advanced cancer.

Plasma and neutrophil fatty acid composition in advanced cancer patients and response to fish oil supplementation

“…Inclusion criteria included: (1) presence of anorexia, defined as 43 on a visual analogue scale; (2) loss of 5% or more of their pre-illness body weight; (3) ability to maintain oral intake, (4) normal cognition, defined as a normal Mini-Mental State examination (Periera et al, 1998) for age and level of education and (5) ability and willingness to give written, informed consent. Eligible participants were randomised using a computergenerated sequence and allocated to receive identical 1 g gelatin capsules containing fish oil (180 mg EPA and 120 mg DHA, Banner Pharmacaps, Olds, AB, Canada) or placebo (olive oil).…”

Antibiotics in palliative medicine—results from a prospective epidemiological investigation from the HOPE survey

“…There is little epidemiological information on the use of antibiotics in palliative care in Germany and only some information from other countries, for example, from Canada [5][6][7], Australia [8], and Norway [9]. Some studies consider the application of antibiotics in the terminal phase of a progressive disease not useful [10,11], whereas other studies describe the importance of antibiotic treatment as a part of symptom control in palliative medicine [8].…”

Feasibility of subcutaneous antibiotics for palliative care patients

“…One third of terminally ill patients develop infections during their final phase of care [4]. The percentage of patients using antibiotics in hospice care ranges from 36% to 84% [5][6]. Antibiotic therapy for the management of neutropenia and non-neutropenic haematologic diseases has been widely described and is regularly updated.…”

“…Antibiotic therapy for the management of neutropenia and non-neutropenic haematologic diseases has been widely described and is regularly updated. However, there is little information regarding the management of antibiotic therapy in palliative care patients [4][5][6][7].…”

“…In palliative care the oral route of administration is advocated as the first choice for the treatment of symptoms [1,[6][7]. However, there are certain situations where this is impossible (gastric intolerance, swallowing disorders, persistent nausea and vomiting, intolerance to oral administration of opioids, malabsorption, extreme weakness, delirium, severe pain) and an alternative route is required [9].…”