Abduh Al-Shaqi Mohammed, Alami Ahmad Hasan, Zahrani Ali Saeed Al-, Al-Marshad Batlah, Muammar Abdulrahman Bin-, M Z Al-Shahri
Riyadh Military Hospital, Saudi Arabia.
Am J Hosp Palliat Care. 2012 Feb;29(1):60-3. doi: 10.1177/1049909111406900. Epub 2011 Jun 15.
In terminally ill cancer patients approaching the dying phase, liberal use of antimicrobials is often viewed by palliative care experts as irrational. No previous reports have reviewed current antimicrobial use in palliative care settings in Saudi Arabia.
The objective of this study was to explore the pattern of antimicrobial use in a tertiary palliative care unit (TPCU) during the last week of patients' life.
Medical records of all patients who died in the TPCU over a 14-month period were reviewed for demographics as well as the frequency and rationale of antimicrobial use during the patients' last week of life. Information on antimicrobial use was obtained from a computerized pharmacy database.
Of 138 patients who died with advanced cancer in the TPCU, 87 (63%) were on one or more antimicrobials during their last week of life. Antibiotics were more frequently used as compared to antifungal and antiviral agents, 64 (46.4%); 45 (32.6%); and 2 (1.5%), respectively. About one third (31.3%) of patients who received antibiotics during their last week of life were prescribed more than one antibiotic. Antimicrobials were mostly given systemically (79%) rather than topically (21%). The most common rationales for antimicrobial prescribing were oral thrush in 36 patients (25.4%), wound care in 29 patients (20.4%), and on empirical basis in 29 patients (20.4%).
The current practice of antimicrobial prescribing, especially for patients who are eminently dying, may need to be reviewed. Initiation of antimicrobial treatment in this group of patients should be based on clear treatment goals and desired outcomes, considering views of patients and families.
在濒临死亡阶段的晚期癌症患者中，姑息治疗专家通常认为大量使用抗菌药物是不合理的。此前尚无报告对沙特阿拉伯姑息治疗机构中当前抗菌药物的使用情况进行综述。
本研究的目的是探讨三级姑息治疗病房（TPCU）患者生命最后一周的抗菌药物使用模式。
回顾了在14个月期间于TPCU死亡的所有患者的病历，以了解人口统计学信息以及患者生命最后一周抗菌药物使用的频率和理由。抗菌药物使用信息来自计算机化药房数据库。
在TPCU因晚期癌症死亡的138例患者中，87例（63%）在生命的最后一周使用了一种或多种抗菌药物。与抗真菌和抗病毒药物相比，抗生素使用更为频繁，分别为64例（46.4%）、45例（32.6%）和2例（1.5%）。在生命最后一周接受抗生素治疗的患者中，约三分之一（31.3%）被开具了不止一种抗生素。抗菌药物大多通过全身给药（79%）而非局部给药（21%）。开具抗菌药物最常见的理由是36例患者（25.4%）的口腔念珠菌病、29例患者（20.4%）的伤口护理以及29例患者（20.4%）的经验性用药。
当前抗菌药物的处方做法，尤其是对于濒临死亡的患者，可能需要重新审视。在这组患者中启动抗菌治疗应基于明确的治疗目标和预期结果，并考虑患者及其家属的意见。
