Hospital Epidemiology and Infection Prevention Program, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Palliat Med. 2023 May;37(5):793-798. doi: 10.1177/02692163231162889. Epub 2023 Mar 31.
Older adults with advanced cancer are exposed to antibiotics but estimates of adverse drug events associated with antibiotic therapy are lacking.
Evaluate the association of antibiotic therapy with adverse drug events in older adults with advanced cancer.
Cohort study where the exposure was the ratio of days of therapy of an oral or intravenous antibiotic per patient-day and the outcome was an adverse drug event, defined as cardiotoxicity, hepatotoxicity, nephrotoxicity, infection, or new detection of a multidrug-resistant organism.
SETTING/PARTICIPANTS: Patients aged ⩾65 years with solid tumors from a tertiary care center who received palliative chemotherapy ( = 914).
Mean age was 75 ± 6.6 years, and 52% were female. Common tumors were lung (31%, = 284) and gastrointestinal (26%, = 234). Mean time from first course of palliative chemotherapy to index admission was 128 days. Five-hundred thirty (58%) patients were exposed to antibiotics during the index admission; of these, 27% ( = 143) met standardized criteria for infection. Patients were commonly exposed to cephalosporins (33%, = 298) and vancomycin (30%, = 276). Among patients exposed to antibiotics, 35% ( = 183/530) developed an adverse drug event. In multivariable testing, antibiotic therapy was associated with development of an adverse drug event (>0 to <1 vs 0 days of therapy/patient-day: adjusted odds ratio [aOR] = 1.9; 95% confidence interval [CI], 1.2-2.8; ⩾1 vs 0 days of therapy/patient-day: aOR = 2.1, 95% CI, 1.4-3.0).
Antibiotic therapy was independently associated with adverse drug events in hospitalized older adults with advanced cancer. These findings may inform antibiotic decision-making among palliative care providers.
晚期癌症的老年患者会接触抗生素，但缺乏与抗生素治疗相关的不良药物事件的估计。
评估抗生素治疗与晚期癌症老年患者不良药物事件的关联。
队列研究，暴露因素为每位患者每天接受口服或静脉内抗生素治疗的天数比，结局为不良药物事件，定义为心脏毒性、肝毒性、肾毒性、感染或新发现多重耐药菌。
地点/参与者：来自三级护理中心的接受姑息化疗的年龄 ⩾65 岁的实体瘤患者（=914）。
平均年龄为 75 ⁇ ± 6.6 岁，52%为女性。常见的肿瘤是肺癌（31%，=284）和胃肠道癌（26%，=234）。从第一疗程姑息化疗到索引入院的平均时间为 128 天。530 名（58%）患者在索引入院期间接触抗生素；其中 27%（=143）符合感染的标准化标准。患者常接触头孢菌素（33%，=298）和万古霉素（30%，=276）。在接触抗生素的患者中，35%（=183/530）发生了不良药物事件。在多变量检验中，抗生素治疗与不良药物事件的发生相关（>0 至<1 与 0 天/患者天治疗：调整后的优势比[aOR] ⁇ 1.9；95%置信区间[CI]，1.2-2.8； ⁇ 1 与 0 天/患者天治疗：aOR ⁇ 2.1，95%CI，1.4-3.0）。
抗生素治疗与晚期癌症住院老年患者的不良药物事件独立相关。这些发现可能为姑息治疗提供者的抗生素决策提供信息。
