The Role of Antibiotics Use in Terminal Cancer Patients

抗生素於末期癌症病人的治療角色

陳琬青(Wan-Chin Chen) ； 蔡佩渝(Pei-Yu Tsai) ； 盧建中(Chien-Chung Lu) ； 林益卿(I-Ching Lin)

《安寧療護雜誌》 15卷1期 (2010/03) Pp. 1-12

https://doi.org/10.6537/TJHPC.2010.15(1).1

摘要

背景：感染是癌症病人首要死因，儘管在安寧病房的高感染率和抗生素的經常使用，目前爲止在緩和醫療的抗生素使用原則尚無共識。
目的：探討安寧療護中抗生素使用與病人存活時間。
方法：作者回顧臺灣中部某醫學中心安寧病房病患之病歷記載，感染的定義是根據病歷中醫師的臨床診斷，部分有細菌培養的佐證。
結果：共有116位癌症病患納入本研究，癌症種類按多寡依序爲肺和支氣管、腸胃道、口腔。有77位病人合計被診斷出94次感染，三分之二是肺炎和泌尿道感染，其中有65位病人共進行109套細菌培養，有39套爲陽性結果，47種病原菌被分離出來，其中綠膿桿菌和克列伯氏菌爲最多。其中接受抗生素治療的有67位病患中發生的80次感染。感染者和非感染者在整體存活上並無顯著差異；此外在排除掉瀕死個案後分析結果顯示，接受抗生素治療者和未接受治療者的感染後存活時間也無顯著差異。儘管抗生素給予方式以靜脈注射居多，其存活時間和僅給口服抗生素者並無顯著差別。
結論：本研究結論認爲當末期癌症病人發生感染時，使用抗生素治療並無法延長其存活時間。

關鍵字

抗生素 ； 感染 ； 癌症 ； 安寧緩和醫療

並列摘要

Background: Infections are the leading cause of death in cancer patients. Despite the high infection rate and frequent use of antibiotics in palliative wards, there is no consensus for antibiotics prescription in this setting currently.
Objective: To investigate the relation of antibiotics use and the survival time in palliative settings.
Methods: We retrospectively reviewed medical charts of cancer patients admitted to the hospice ward in a medical center of middle Taiwan. The presence of infections was identified by symptoms and signs in medical records, with or without microbial investigations.
Results: A total of 116 patients were included in the study. The most frequent primary sites of malignancies were lung and bronchus, gastrointestinal tract and mouth cavity. There were 77 patients with totally 94 infection episodes diagnosed. Two thirds of them were pneumonia and urinary tract infections. There were 39 positive results of 109 cultures performed in 65 patients. 47 organisms were isolated. Pseudomonas and Klebsiella pneumoniae were the most common pathogens therein. 67 patients with 80 infection episodes were treated with antibiotics. There was no significant difference of overall survivals between infected and uninfected groups. Among the infected patients, post-infection survivals between those treated with antibiotics and left untreated were not significantly different, after exclusion of pre-dying patients. Although most of the patients received antibiotics intravenously, their post-infection survival did not significantly differ from those with oral antibiotics only.
Conclusion: Our study concluded that in infected terminal cancer patients, the use of antibiotics could not prolong their lives.

並列關鍵字

antibiotics ； infection ； cancer ； hospice palliative care