Estudio retrospectivo del uso de antimicrobianos en pacientes que fallecen en un servicio de oncología

Introduction: Infections at the end of life in cancer patients are an important cause of morbidity and mortality, and the indications for antibiotic therapy in this context are not clear. Objectives: Describe the use of antibiotics at the end of life and analyze its relationship with the characteristics of the oncological disease, functional status and probability of discharge upon admission. Methodology: Retrospective study of deceased patients in the oncology ward limited to a period of 7 months between May 1 and December 31, 2019. The number of patients included was 101. The percentage of patients who received antibiotic treatment during their admission and the time elapsed between the last dose and exitus lethalis were evaluated. Results: The mean age was 65.3 years and 54.5 % were men. 23.7 % had an ECOG<2, 63.3 %≥2. The most frequent location of the primary tumor was the lung (38.6 %). 53 % of the patients received palliative chemotherapy at the time of admission, and 66.3 % were in disease progression. In 72.3 % the probability of discharge upon admission was low. The main suspected infectious focus was the respiratory (27.7 %) followed by the abdominal (18.8 %). 58.4 % received antibiotic treatment. The most frequently used antimicrobial was amoxicillin-clavulanate (36.2 %). Regarding the search for the microorganism responsible for the patient's probable infectious condition, blood culture was obtained in 23 patients (23 %), urine culture in 12 (12 %), stool culture in 7 (7 %) and sputum culture in 10 patients (10 %). Microorganisms were isolated in 9 blood cultures, 4 urine cultures, one stool culture and 2 sputum cultures respectively. The most frequently isolated microorganisms in the positive cultures were: Escherichia coli (4), Pseudomonas aeruginosa (2) and Clostridium perfringens (2). Conclusion: The population of patients receiving antimicrobials at the end of life is quite homogeneous in terms of its clinical characteristics and presents a high incidence of infections with a high frequency of antimicrobial use. Although 58 % of the patients received antimicrobials, in only 23 % the causative agent was identified. This is a retrospective study with a small sample of patients and further prospective studies are necessary.