De Silva Nivanka, Jackson Justin, Steer Christopher
Faculty of Medicine, University of New South Wales (UNSW) Rural Clinical School, Albury Campus, Albury, New South Wales, Australia.
Albury Wodonga Health, Albury, New South Wales, Australia.
Intern Med J. 2018 Mar;48(3):323-329. doi: 10.1111/imj.13646.
Infections and antibiotic resistance patterns in patients attending regional Australian cancer centres are poorly described.
To document patient characteristics, infection types, patterns of antibiotic resistance and outcomes in all patients with cancer requiring inpatient management for suspected infection at a regional Australian cancer centre.
We studied patients ≥18 years of age who were admitted under the oncology unit at Albury Wodonga Health during a 12-month period and who had a microbiological test performed for suspected infection during their admission. Data were extracted retrospectively from electronic records and analysed through descriptive statistics.
We identified 275 episodes of suspected infection occurring in 208 patients (M/F: 61%/39%). Median age was 68 years, solid tumour 76%, haematological malignancy 24%. A positive culture was obtained in 28% of cases: Gram-positive 48.5% and Gram-negative 51.5%. Drug resistant Pseudomonas aeruginosa was seen in 38% (5/13) of pseudomonas isolates, three times the rate seen in general hospital admissions. Extended spectrum beta lactamase was seen in 22% of Gram-negative isolates. Empiric IV antibiotic choice was guideline concordant in 61% of neutropenic fever (NF) (NF) presentations. Only 17% of NF presentations received antibiotics within the recommended hour of emergency department triage. The inpatient mortality rate was 3%. Fifty-seven percent of NF presentations satisfied Multinational Association of Supportive Care in Cancer risk index criteria for outpatient management.
This is the first study of this type in patients with cancer at an Australian regional cancer centre. The study highlighted key areas for improvement in antibiotic prescription and control of antibiotic resistance at our institution.
澳大利亚地区癌症中心患者的感染情况及抗生素耐药模式鲜有描述。
记录澳大利亚地区癌症中心所有因疑似感染需住院治疗的癌症患者的特征、感染类型、抗生素耐药模式及转归。
我们研究了在阿尔伯里沃东加健康中心肿瘤病房住院12个月且因疑似感染进行微生物检测的18岁及以上患者。数据从电子记录中回顾性提取，并通过描述性统计进行分析。
我们确定了208例患者中发生的275次疑似感染事件（男/女：61%/39%）。中位年龄为68岁，实体瘤患者占76%，血液系统恶性肿瘤患者占24%。28%的病例培养结果呈阳性：革兰氏阳性菌占48.5%，革兰氏阴性菌占51.5%。在铜绿假单胞菌分离株中，38%（5/13）发现耐药菌株，是综合医院住院患者中该比例的三倍。22%的革兰氏阴性菌分离株检测到超广谱β-内酰胺酶。61%的中性粒细胞减少伴发热（NF）患者的经验性静脉用抗生素选择符合指南。只有17%的NF患者在急诊科分诊推荐时间内接受了抗生素治疗。住院死亡率为3%。57%的NF患者符合癌症支持治疗多国协会门诊管理风险指数标准。
这是澳大利亚地区癌症中心针对癌症患者进行的此类首次研究。该研究突出了我们机构在抗生素处方及抗生素耐药控制方面需改进的关键领域。
