探討接受安寧共照的癌末病人在生命最後一星期使用抗生素情形--台灣某區域教學醫院之研究

Antibiotics Use in the Last Week of Life among Advanced Cancer Patients under the Hospice Shared Care Service Model -- A study of Regional Teaching Hospital in Taiwan

背景及目的：感染對癌末病人是一項嚴重的併發症，也是造成病人死亡的主要死因。本研究目的在探討癌末病人在生命最後一星期抗生素使用的相關因子。
方法：本研究為病例回顧法，收集2011年1月到2012年12月間，因癌症死亡的病人為對象，登錄病人最後一次住院的基本人口學資料、使用抗生素種類與適應症、及病人死亡等資料。
結果：共417位癌症末期病人納入分析，其中258人(61.9%)在生命最後一星期有使用抗生素。最常使用的抗生素為頭孢子菌素(cephalosporin)，占29.7%。病人使用抗生素常見的原因有肺炎(41.5%)及敗血症(36.8%)。癌症末期病人在生命最後一星期使用抗生素的危險因子包括病人年齡較長且有發燒者（勝算比，Odds Ratio (OR)=1.09），入住加護病房者(OR=3.11)，放置鼻胃管者(OR=2.47)，放置導尿管者(OR=1.98)，有中風病史者(OR=4.70)，以及血液檢查CRP值較高者(OR=1.06)，與白血球較高者(OR=1.03)；但肺癌的患者有較低的比例使用抗生素(OR=0.36)。
結論：本研究觀察到在生命最後一星期有超過六成的癌末病人會使用抗生素並報告其相關因子。對於癌症末期病人使用抗生素後在症狀上的改善情形則未探討，這可能是未來研究的方向。

Background: Infection is a serious complication and a leading cause of death for patients with cancers. The associated risk factors or predictors of antibiotics use in the last week of life in patients with advanced cancers were not clear in Taiwan.
Aim: To identify the risk factors or predictors associated with antibiotic uses in advanced cancer patients in the last week of life.
Method: The data were collected retrospectively by reviewing medical records of deceased advanced cancer patients from January 2011 to December 2012 in a Metropolitan teaching hospital.
Results: Among 417 enrolled subjects, 258 (61.9%) patients received antibiotics. The cephalosporin (29.7%) was the most used. Patients with pneumonia (41.5%) or septicemia (36.8%) accounted for most indications of infection. The significant risk factors or predictors that increased antibiotic uses were age of patients with fever (OR=1.09, 95% C.I.: 1.06-1.14), intensive care unit (ICU) admission (OR=3.11, 95% C.I.: 1.39-7.30), insertion of nasogastric tube (OR=2.47, 95% C.I.: 1.39-4.46), urinary catheterization (OR=1.98, 95% C.I.: 1.08-3.62), comorbidity with cerebral vascular accident (OR=4.70, 95% C.I.: 1.28-20.80), higher C-reactive protein levels (OR=1.06, 95% C.I.: 1.02-1.11), and higher white blood cell counts (OR=1.03, 95% C.I.: 1.01-1.06), but lung cancer patients (OR=0.36, 95% C.I.: 0.17-0.72) were less likely to use antibiotics.
Conclusion: More than one half of patients with advanced cancers received antibiotics in the last week of life. Our study revealed that significant risk factors or predictors of antibiotics uses for advanced cancer patients. Yet, further study is needed to examine whether symptoms are improved with antibiotics uses or not.