The pattern of infection and antibiotics use in terminal cancer patients

Mohammed, Amrallah A.; Al-Zahrani, Abdullah S.; Sherisher, Mohamed A.; Alnagar, A.A.; Elshentenawy, Ayman; El-Kashif, Amr T.

doi:10.1016/j.jnci.2014.05.002

Cited by 15 publications

(20 citation statements)

References 25 publications

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“…[5][6][7][8][9] As a result, antibiotic use is common among hospitalized patients with advanced cancer. [10][11][12] Moreover, following transition to comfort measures, approximately one-third of hospitalized patients with advanced cancer continue to receive antibiotic therapy. 10,13 A variety of complex social and behavioral factors may drive antibiotic prescribing in this population.…”

Section: Introductionmentioning

confidence: 99%

Increased Length of Stay Associated With Antibiotic Use in Older Adults With Advanced Cancer Transitioned to Comfort Measures

Datta

Zhu

Han

et al. 2019

Am J Hosp Palliat Care

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Background: Antibiotic use may increase hospital length-of-stay (LOS) among older patients with advanced cancer who are transitioned to comfort measures. Methods: We studied a cohort of advanced cancer patients aged ≥ 65 years who were transitioned to comfort measures during admission from July 1, 2014 through November 30, 2016. We evaluated the association between antibiotic exposure and LOS using a Poisson regression model adjusted for age, gender, cancer type, comorbidities, infection, and intensive care unit admission. Results: Among 461 advanced cancer patients, median age was 74 years (range 65–99), 49.0% (n=226) were female, and 20.6% (n=95) had liquid tumors. Overall, 82.9% (n=382) received ≥1 antibiotic and 64.6% (n=298) had ≥1 infection diagnosis during hospitalization. Infection diagnoses commonly included sepsis (35%, n=16¼61), pneumonia (25%, n=117/461), and urinary tract infection (14%, n=66/461). Among those receiving antibiotics, the most common choices included vancomycin (79%, n=300/382), cephalosporins (63%, n=241/382), and penicillins (45%, n=172/382). In a multivariable Poisson regression model, LOS was 34% longer (count ratio=1.34, [95% CI: 1.20–1.51]) among those exposed versus unexposed to antibiotics. Conclusions: Antibiotic use among advanced cancer patients who are transitioned to comfort measures is associated with longer LOS. These data illustrate the importance of tradeoffs associated with antibiotic use, such as unintended increased LOS, when striving for goal-concordant care near the end of life.

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Section: Introductionmentioning

confidence: 99%

Increased Length of Stay Associated With Antibiotic Use in Older Adults With Advanced Cancer Transitioned to Comfort Measures

Datta

Zhu

Han

et al. 2019

Am J Hosp Palliat Care

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“…In total, 22 studies assessed patients with advanced cancer in EOL care (Supplementary Table 1). All included studies were retrospective cohort studies (18 studies) [15][16][17][18][20][21][22][23][24][25][27][28][29][30][31][32]34,35 or prospective cohort studies (4 studies). 19,26,33,36 Most of the studies were conducted at an academic medical center (8 studies) [16][17][18]23,25,28,30,35 or a hospice or home care (n = 5 studies).…”

Section: Eol Care Patients With Advanced Cancermentioning

confidence: 99%

“…36 In 14 EOL studies, the time before death was not stated. 16,18,19,21,23,[25][26][27]29,[31][32][33][34][35] In combination, these studies included 35,239 patients with advanced cancer. Moreover, 16 studies (4,707 patients, 13.4%) included patients with any type of cancer (solid or hematologic malignancy).…”

Section: Eol Care Patients With Advanced Cancermentioning

confidence: 99%

Antibiotic use during end-of-life care: A systematic literature review and meta-analysis

Marra

Puig-Asensio

Balkenende

et al. 2020

Infect. Control Hosp. Epidemiol.

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Background: We performed a systematic literature review and meta-analysis measuring the burden of antibiotic use during end-of-life (EOL) care. Methods: We searched PubMed, CINAHL (EBSCO platform), and Embase (Elsevier platform), through July 2019 for studies with the following inclusion criteria in the initial analysis: antibiotic use in the EOL care patients (advanced dementia, cancer, organ failure, frailty or multi-morbidity). If the number of patients in palliative care consultation (PCC) was available, antibiotic use data were pooled to compare the proportion of patients who received antibiotics under PCC compared to those not receiving PCC. Random-effect models were used to obtain pooled mean differences, and heterogeneity was assessed using the I2 value. Results: Overall, 72 studies met the inclusion criteria and were included in the final review: 22 EOL studies included only patients with cancer; 17 studies included only patients with advanced dementia; and 33 studies included “mixed populations” of EOL patients. Although few studies reported antibiotic using standard metrics (eg, days of therapy), 48 of 72 studies (66.7%) reported antibiotic use in >50% of all patients. When the 3 studies that evaluated antibiotic use in PCC were pooled together, patients under PCC was more likely to receive antibiotics compared to patients not under PCC (pooled odds ratio, 1.73; 95% CI, 1.02–2.93). Conclusions: Future studies are needed to evaluate the benefits and harms of using antibiotics for patients during EOL care in diverse patient populations.

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“…11 However, the decision to prescribe antimicrobials during end-of-life care is predominantly driven by physicians. 12 There is weak evidence supporting the use of antimicrobials to achieve relief of symptoms in palliative care settings, 7,11,13,14 but strong evidence of harm including an increased risk for antimicrobial resistance, 15 which may limit the efficacy of existing antimicrobials 16 and contribute to 10 million deaths by 2050. 17 Different factors compel physicians to prescribe antimicrobials during end-of-life care.…”

Section: Introductionmentioning

confidence: 99%

Education needed to improve antimicrobial use during end-of-life care of older adults with advanced cancer: A cross-sectional survey

et al. 2020

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Background: Antimicrobial use during end-of-life care of older adults with advanced cancer is prevalent. Factors influencing the decision to prescribe antimicrobials during end-of-life care are not well defined. Aim: To evaluate factors influencing medicine subspecialists to prescribe intravenous and oral antimicrobials during end-of-life care of older adults with advanced cancer to guide an educational intervention. Design: 18-item single-center cross-sectional survey. Setting/participants: Inpatient medicine subspecialists in 2018. Results: Of 186 subspecialists surveyed, 67 (36%) responded. Most considered withholding antimicrobials at the time of clinical deterioration during hospitalization ( n = 54/67, 81%), viewed the initiation of additional intravenous antimicrobials as escalation of care ( n = 44/67, 66%), and believed decision-making should involve patients or surrogates and providers ( n = 64/67, 96%). Fifty-one percent ( n = 30/59) of respondents who conducted advance care planning did not discuss antimicrobials. Barriers to discussing end-of-life antimicrobials included the potential to overwhelm patients or families, challenges of withdrawing antimicrobials, and insufficient training. Conclusions: Although the initiation of additional intravenous antimicrobials was viewed as escalation of care, antimicrobials were not routinely discussed during advance care planning. Educational interventions that promote recognition of antimicrobial-associated adverse events, incorporate antimicrobial use into advance care plans, and offer communication simulation training around the role of antimicrobials during end-of-life care are warranted.

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The pattern of infection and antibiotics use in terminal cancer patients

Abstract: Our study revealed that antibiotic therapy for terminal cancer patients should be on a clear rationale. We need further study to clarify if there is survival effect with antibiotic use or not.

Cited by 15 publications

References 25 publications

Increased Length of Stay Associated With Antibiotic Use in Older Adults With Advanced Cancer Transitioned to Comfort Measures

Increased Length of Stay Associated With Antibiotic Use in Older Adults With Advanced Cancer Transitioned to Comfort Measures

Antibiotic use during end-of-life care: A systematic literature review and meta-analysis

Education needed to improve antimicrobial use during end-of-life care of older adults with advanced cancer: A cross-sectional survey

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