Lam Po Tin, Chan Kin Sang, Tse Chun Yan, Leung Man Wai
Division of Palliative Care, United Christian Hospital, Kowloon, Hong Kong.
J Pain Symptom Manage. 2005 Dec;30(6):536-43. doi: 10.1016/j.jpainsymman.2005.06.005.
Infection is common among advanced cancer patients. This study was undertaken to review the pattern of use of antibiotics and to identify potential factors that could affect outcomes after infection. The medical records of all patients with advanced cancer who were enrolled into the palliative care service of a district hospital during the period January, 2002 to July, 2002 were retrospectively reviewed for infections and the use of antibiotics. Among the eligible 87 patients, 17 did not have any infective episode and 70 had at least one infective episode and accounted for a total of 120 episodes. Sixty-eight episodes were associated with survival for >14 days, and 52 episodes were associated with survival of < or =14 days. The most frequent sites of infection were chest (n=63, 52.5%), urinary tract (n=35, 29.2%), and skin/wound (n=6, 5%). Antibiotics were prescribed for 97.5% (n=117) episodes. The use of second-line antibiotics was 16.2% (n=19). By multivariate logistic regression analysis, dyspnea [odds ratio (OR)=2.6, 95% confidence interval (CI)=1.1-6.3], antibiotic utilization pattern [empirical therapy (OR=4.8, 95% CI=1.7-13.2) vs. therapy according to antibiotic sensitivity], and route of administration [parenteral route (OR=3.3, 95% CI=1.3-8.2) vs. oral route] were identified as independent determinants affecting survival after infection. Dyspnea was possibly associated with poor prognosis during the treatment of infections in patients with advanced cancer, and antibiotic therapy according to sensitivity was associated with better prognosis. Further studies are encouraged to verify this. The bioethical principles on the use of antibiotics as a life-sustaining treatment should always be followed.
感染在晚期癌症患者中很常见。本研究旨在回顾抗生素的使用模式，并确定可能影响感染后结局的潜在因素。对2002年1月至2002年7月期间纳入某地区医院姑息治疗服务的所有晚期癌症患者的病历进行回顾，以了解感染情况和抗生素使用情况。在符合条件的87例患者中，17例未发生任何感染事件，70例至少发生1次感染事件，共120次感染发作。68次发作与存活超过14天相关，52次发作与存活≤14天相关。最常见的感染部位是胸部（n = 63，52.5%）、尿路（n = 35，29.2%）和皮肤/伤口（n = 6，5%）。97.5%（n = 117）的发作使用了抗生素。二线抗生素的使用比例为16.2%（n = 19）。通过多因素逻辑回归分析，呼吸困难[比值比（OR）= 2.6，95%置信区间（CI）= 1.1 - 6.3]、抗生素使用模式[经验性治疗（OR = 4.8，95% CI = 1.7 - 13.2）与根据抗生素敏感性进行的治疗]以及给药途径[肠外途径（OR = 3.3，95% CI = 1.3 - 8.2）与口服途径]被确定为影响感染后存活的独立决定因素。呼吸困难可能与晚期癌症患者感染治疗期间的预后不良有关，而根据敏感性进行抗生素治疗与较好的预后相关。鼓励进一步研究以验证这一点。在使用抗生素作为维持生命治疗时，应始终遵循生物伦理原则。
