我院恶性肿瘤临终患者感染及抗菌药物使用分析
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篇名: 我院恶性肿瘤临终患者感染及抗菌药物使用分析
TITLE:
摘要: 目的:为恶性肿瘤临终患者抗菌药物的合理使用提供参考。方法:对2013年3月-2016年3月在我院肿瘤内科死亡的恶性肿瘤住院患者的一般情况、感染情况及抗菌药物使用情况进行了回顾性分析。结果:149例入选患者中,共113例(75.8%)患者的129次感染被发现。最常见感染部位为肺部(65.9%),其次为消化道/腹腔(13.2%)与皮肤/创口(6.2%)。100例(67.1%)患者使用抗菌药物,其中61.1%的患者为经验性治疗。β-内酰胺类/β-内酰胺酶抑制剂(41.8%)、喹诺酮类(21.7%)及头孢菌素类(16.9%)为最常被使用的3类抗菌药物。抗菌药物治疗有效率低至15.8%,其有效性与感染发生时距离死亡时间(P<0.001)、感染发生时卡氏(KPS)评分(P<0.001)及抗菌药物治疗时长(P=0.025)有关。结论:恶性肿瘤临终患者易受感染,尤其是肺部感染。经验性广谱抗菌药物在恶性肿瘤临终患者中应用广泛,但治疗有效率低。对于KPS评分<60分的临近死亡的恶性肿瘤患者,若无效抗菌药物治疗已超过7 d,适时终止抗菌药物治疗是较好选择。
ABSTRACT: OBJECTIVE: To provide reference for rational use of antibiotics in terminal stage patients with malignant tumor. METHODS: The inpatients with malignant tumor who died in the department of medical oncology of our hospital from Mar. 2013 to Mar. 2016 were analyzed retrospectively in respects of general situation, infection situation and antibiotics use. RESULTS: Among 149 inpatients, a total of 129 infection cases were found in 113 patients (75.8%). The most frequent sites of infection were lung (65.9%), followed by digestive tract/abdomen (13.2%), and skin/wound (6.2%). 100 patients  (67.1%) received antibiotics, 61.1% of which were empiric treatment. β-lactam/β-lactam lactamase inhibitor (41.8%), fluoroquinolone (21.7%) and cephalosporin (16.9%) were the top 3 frequently prescribed antibiotics. The effective rate of antibiotics treatment was as low as 15.8%, which was believed to be linked with the survival duration since infection occurred (P<0.001), the Karnofsky performance scale (KPS) score when infection occurred (P<0.001) and the duration of antibiotics treatment (P=0.025). CONCLUSIONS: Terminal stage patients with malignant tumor are vulnerable to infections, especially to pulmonary infection. The empirical broad-spectrum antibiotics are widely used in terminal patients with malignant tumor, but the effectiveness rate of antibiotic treatment is in low level. For those terminal stage patients with malignant tumor and with KPS score<60 points, when futile antibiotics treatment last for more than 7 days, timely termination of antibiotics treatment is a better choice.
期刊: 2016年第27卷第35期
作者: 张颖佩,吴东方,程虹,杨坤
AUTHORS: ZHANG Yingpei,WU Dongfang,CHENG Hong,YANG Kun
关键字: 恶性肿瘤;临终患者;感染;抗菌药物
KEYWORDS: Malignant tumor; Terminal stage patients; Infection; Antibiotics
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