Bacterial infections in terminally ill hospice patients

Terminally ill patients are very susceptible to infections, which are the r esult of disease-related processes and/or therapy-induced mechanisms. These patients are already subject to multiple severe symptoms and associated co morbid conditions, with much resultant distress. Infection increases this s ymptom burden and further reduces quality of life. We have retrospectively investigated the prevalence of infection and clinical course in 102 consecu tive patients who died after admission to at tertiary palliative care unit and assessed the site-specific frequency of infection, pathogenic organisms involved, and the pattern of antibiotic agents used. The prevalence of sym ptoms and comorbid conditions on admission and during the progress phase of care were noted. Median overall survival of the total cohort was 12 days. The median survival of patients with infections was 22 days. Thirty-seven p atients (36.3%) were diagnosed with 42 separate infections. The sites of in fections were the urinary tract (42.5%), the respiratory tract (22.9%), blo od (12.5%), skin and subcutaneous tissues (12.5%), and the eyes (10.0%). Th ere were 20 separate positive cultures isolated from specimens obtained fro m 13 individual patients. Three isolates were obtained from 1 patient, 2 is olates obtained from 5 patients, and 1 isolate was obtained from each of th e 7 remaining patients. Escherichia coli was the most common pathogen isola ted. Eleven patients with infections (31.4%) were diagnosed on admission, a nd antibiotic treatment was commenced within 48 hours of admission in 21 pa tients (60%). 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 = 0.001) as were disabling symptoms on admission, such as pain, immobility, and weakness. Symptoms indicating poor survival, such as severe pain and dyspnea, were not significantly associated with in fection. Decreased patient survival in this cohort was not significantly as sociated with the presence of bacterial infection (P = 0.07), irrespective of whether or not a positive culture isolate was obtained. We conclude that appropriate management of infection resulted in enhanced palliative sympto m control. J Pain Symptom Manage 2000;20:326-334. (C) U.S. Cancer Pain Reli ef Committee, 2000.