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Impact of Infections on the Survival of Hospitalized Advanced Cancer Patients

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Published:25th Mar 2020
Context: Advanced cancer patients remain highly susceptible to infections, leading to significant morbidity and mortality. A lack of consensus on the management of infections in this population stems from the heterogeneity of the patient group, divergent goals of care, and unknown prognosis with antibiotic treatment. Objectives: This prospective single cohort study examined the impact of infection and its treatment on the survival of hospitalized advanced cancer patients compared with a similar cohort without infection. Methods: A total of 441 patients were referred to the palliative care (PC) consult service in a tertiary hospital over a 12-month period. The occurrence of sepsis, organ-related infection, and antibiotic use were recorded on initial PC consult. Survival was calculated from the point of PC consult to the date of death. Results: Of these patients, 16.6% suffered a recent episode of sepsis (with or without an identifiable organ-related infection) and 23.4% had a recent episode of organ-related infection without clinically evident sepsis. Among the patients with sepsis, organ-related infection, or both, 89.7% received antibiotics (intravenous, oral, or both). Median survival of septic and nonseptic patients was 15 and 42 days, respectively. Septic patients who responded poorly to treatment (nonresponders) had a median survival of five days vs. 142 days in good responders. This equates with a hazard ratio of 9.74 for death in antibiotic nonresponders (P<0.05). median survival for patients with an untreated organ-related infection (no sepsis) was 27 days compared with 48 days in a similar cohort receiving antibiotic therapy. among patients on iv antibiotics, nonresponders had a median survival of six days vs. 108 days in responders. for patients on oral antibiotics, nonresponders had a median survival of six days vs. 70 days in responders. conclusion: these findings suggest that a recent episode of sepsis and or organ-related infection significantly reduces overall patient survival. favorable antibiotic response is associated with an increase in median survival. these findings suggest that antibiotic treatment may prolong survival, and a time-limited trial may be indicated contingent on goals of care.>

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