Analysis of Infection and Antibiotics Use in Terminal Cancer Patients in a Hospice Ward in Southern Taiwan

臺灣南部一安寧病房癌症末期病患感染與抗生素治療結果之回顧性分析

林正耀(Cheng-Yao Lin) ； 林維君(Wei-Chun Lin) ； 黃文聰(Wen-Tsung Huang) ； 馮盈勳(Yin-Hsun Feng) ； 曹朝榮(Chao-Jung Tsao)

《台灣癌症醫學雜誌》 28卷2期 (2012/06) Pp. 57-67

https://doi.org/10.6323/JoCRP.2012.28.2.1

摘要

背景：感染是癌症患者常見的問題之一，但是針對末期癌症患者感染時是否應使用抗生素治療，則是相對複雜且存在許多爭議。方法：我們藉由一南臺灣區域型教學醫院之緩和照護病房中進行一項回顧性研究。針對癌末病患在其臨終之前最後一次住院期間，調查感染的盛行率、相關的特性、潛在感染的風險因子、抗生素使用的比率以及使用後的結果。結果：從2007年5月到2008年2月，共登錄168名病患。男性人數是女性人數的兩倍（男/女：112/56），平均年齡是64.2歲。共計有115名病患（68.5%）被認定有感染，並導致123次感染事件（一次/兩次：107/8）。有感染的患者之中，87名（75.7%）是在入住緩和照護病房時已有感染；而28名（24.3%）則是在入住後受到新的感染。呼吸道、泌尿道和皮膚傷口是感染的主要部位。綠膿桿菌（Pseudomonas aeruginosa）是最常見的致病菌，體內置入導管數量和護理照顧需求的次數多寡則是感染的主要風險因子。絕大多數感染事件有接受抗生素治療（122/123，99.2%），在抗生素治療以後，67個事件（54.9%）改善了感染相關的症狀，其中發燒和呼吸困難的緩解是最常見的。感染患者的平均住院天數明顯較未感染者多（11.95天對6.87天，p=.001）。結論：我們的研究結果顯示抗生素治療對末期癌症患者的感染有些微的好處。然而尋找更多適當的因素作為抗生素使用在癌症末期患者感染的指引仍需要進一步研究。

關鍵字

癌症 ； 末期 ； 感染 ； 抗生素

並列摘要

Background: Infection is one of the common problems that occurs in cancer patients, but antibiotic therapy for terminal cancer patients is complicated and remains controversial.Methods: We retrospectively collected medical records from a palliative care ward in southern Taiwan. Data included the prevalence, characteristics, potential risks of infection, and the outcomes after administration of antibiotic prescriptions through final hospital admission prior to patient death.Results: From May 2007 to February 2008, a total of 168 eligible patients were enrolled. There were twice as many males enrolled than females (M/F: 112/56), and the mean age was 64.2 years. Infections were recognized in 115 patients (68.5 %) with a total of 123 infection episodes (once/twice: 107/8). Among those infected patients, 87 patients (75.7 %) had infection upon admission, and 28 patients (24.3 %) had new infection after admission. The most prevalent locations for infection in patients were the respiratory tract, urinary tract and the skin, and Pseudomonas aeruginosa was the most common pathogen. The number of foreign body implantations and nursing care demands were risk factors for infection. Most infections (99.2%) were treated by antibiotics, after which the symptoms of infection improved in 67 patient events (54.9 %); fever and dyspnea relief were the most commonly seen symptoms. The mean duration of hospitalization was significantly longer for infected patients than for uninfected patients (11.95 days vs. 6.87 days, p = .001).Conclusions: Our study revealed that antibiotic therapy provides modest benefits for terminal cancer patients. However, further studies to ascertain the optimal factors as a guide for antibiotic use in infected terminal cancer patients are necessary.

並列關鍵字

cancer ； terminal ； infection ； antibiotics