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clinmed/2000030003v1 (April 6, 2000)
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Bacterial Infections in Terminally Ill Patients
Luis Vitetta, David Kenner, and Avni Sali
Objectives: To investigate the prevalence of infections and clinical course, in a series of patients who died after admission to a tertiary palliative care unit, and to assess the site specific frequency of infection, pathogenic organisms involved, and the pattern of antibiotic agents utilised.
Design: This study was a retrospective case review of 102 consecutive patients.
Setting: All patients had been admitted to a tertiary palliative care unit for palliation of symptoms during their terminal phase of care.
Participants: Of 102 consecutive patients, 94 patients were diagnosed with malignant diseases and 8 with non malignant diseases.
Main Outcome Measures: Median overall survival of the total cohort was 12 days. The median survival of patients with infections was 22 days. Thirty seven patients (36.3%)were diagnosed with 42 separate infections. The sites of infections were the urinary tract (42.5%), the respiratory tract (22.9%), blood (12.5%), skin and subcutaneous tissues (12.5%) and the eyes (10%). Escherichia Coli was the most common pathogen isolated. Eleven patients with infections (31.4%) were diagnosed on admission and antibiotic treatment commenced within 48 hours of admission in 21 (60%)patients.
Conclusions: Overall antibiotic response and symptom control of infections was observed to be a minimum of 40%. Psychological distress was common in this group of patients (P<.001)as were disabling admission symptoms such as pain, immobility and weakness. However symptoms indicating poor survival such as severe pain and dyspnea were not significantly associated with this subgroup. Decreased patient survival was not significantly associated with the presence of bacterial infection (P<.07), irrespective of whether or not a positive culture isolate was obtained. We conclude that appropriate management of infection resulted in enhanced palliative symptom control.