Bacteria Grown in Various Clinical Samples of Palliative Service Patients and Antibiotic Resistance Rates
Abstract
Knowing the current infectious agent profile and antibiotic resistance patterns in palliative service patients is of great importance in terms of empirical treatment management until the culture and antibiogram results are determined. Our study aimed to investigate the distribution of microorganisms isolated from clinical samples of patients receiving inpatient treatment in the palliative service of our hospital and the antibiotic resistance profiles of these isolates.
In this study, clinical samples sent to the microbiology laboratory of 264 patients hospitalized in the palliative service of Samsun Gazi State Hospital between 2022 and 2023 were evaluated.
The median age of the patients was 76 years (range: 65-87), and 41% of the patients were male. The most common causes of urinary tract infections were Klebsiella spp. (27.4%) and Escherichia coli (27.4%), the most common respiratory tract infection agent was Acinetobacter baumannii (36.7%), and the most common wound infection agent was Pseudomonas aeruginosa (30%). Lowest resistance rates were against ceftazidime-avibactam (4.8%) and colistin (9.5%) in Klebsiella isolates; ceftazidime-avibactam (0%), colistin (0%), imipenem (7.1%) and meropenem (7.1%) in E. coli isolates; colistin (7.1%) in Acinetobacter isolates. 0%); colistin (0%) and ceftazidime-avibactam (23.1%) in Pseudomonas isolates; and vancomycin (0%) in Enterococcus isolates.
The findings obtained from our study indicate that Klebsiella and E. coli are the most common causes of urinary and bloodstream infections in palliative service patients, and that ceftazidime-avibactam and colistin are the most effective treatment options in these infections, and that colistin is the most effective treatment option in cases caused by Acinetobacter and Pseudomonas.
References
- Arkın FS, Cenger DH. Palyatif klinikte yatan kanser hastalarının kan kültürü sonuçlarının değerlendirilmesi. IKKSTD 2022;14(3):262-7. doi: 10.14744/iksstd.2022.99705
- Béziaud N, Pavese P, Barnoud D, Laval G. Infections bactériennes en soins palliatifs : antibiothérapies et limitations thérapeutiques [Bacterial infections in palliative care: antibiotics and therapeutic limitations]. Presse Med. 2009;38(6):935-44. doi:10.1016/j.lpm.2008.10.013
- Chen LK, Chou YC, Hsu PS, et al. Antibiotic prescription for fever episodes in hospice patients. Support Care Cancer. 2002;10(7):538-41. doi:10.1007/s00520-002-0377-9
- Clark MD, Halford Z, Herndon C, Middendorf E. Evaluation of antibiotic initiation tools in end-of-life care. Am J Hosp Palliat Care. 2022;39(3):274-81. doi:10.1177/10499091211027806
- Dagli O, Tasdemir E, Ulutasdemir N. Palliative care infections and antibiotic cost: a vicious circle. Aging Male. 2020;23(2):98-105. doi:10.1080/13685538.2019.1575353
- Durand M, Forestier E, Gras Aygon C, et al. Determinants of doctors' antibiotic prescriptions for patients over 75 years old in the terminal stage of palliative care. Infect Dis Now. 2021;51(4):340-5. doi:10.1016/j.medmal.2020.10.013
- Dyer J, Vaux L, Broom A, Broom J. Antimicrobial use in patients at the end of life in an Australian hospital. Infect Dis Health. 2019;24(2):92-7. doi:10.1016/j.idh.2018.12.001
- Garg VK, Mishra S, Gupta N, et al. Microbial and antibiotic susceptibility profile among isolates of clinical samples of cancer patients admitted in the intensive care unit at regional tertiary care cancer center: A retrospective observational study. Indian J Crit Care Med. 2019;23(2):67-72. doi:10.5005/jp-journals-10071-23119
- Hart E, Snape S, Thomson R. Palliative outpatient parenteral antibiotic therapy: a review of 5 years of patient data. JAC Antimicrob Resist. 2020;2(3):dlaa052. doi:10.1093/jacamr/dlaa052
- Henri B, Sirvain S, de Wazieres B, et al. Enquête de pratique sur les modalités de prescription des antibiotiques en phase terminale de soins palliatifs chez les patients de plus de 75 ans [Survey on antibiotic prescription practices for palliative care terminally ill patients of 75 years old and more]. Rev Med Interne. 2022;43(10):589-95. doi:10.1016/j.revmed.2022.08.011
- Hung KC, Lee LW, Liew YX, et al. Antibiotic stewardship program (ASP) in palliative care: antibiotics, to give or not to give. Eur J Clin Microbiol Infect Dis. 2022;41(1):29-36. doi:10.1007/s10096-021-04325-z
- Kim JH, Yoo SH, Keam B, Heo DS. Antibiotic prescription patterns during last days of hospitalized patients with advanced cancer: the role of palliative care consultation. J Antimicrob Chemother. 2023;78(7):1694-700. doi:10.1093/jac/dkad156
- Kim JH, Yoo SH, Keam B, Heo DS. The impact of palliative care consultation on reducing antibiotic overuse in hospitalized patients with terminal cancer at the end of life: a propensity score-weighting study. J Antimicrob Chemother. 2022;78(1):302-8. doi:10.1093/jac/dkac405
- Macedo F, Nunes C, Ladeira K, et al. Antimicrobial therapy in palliative care: an overview. Support Care Cancer. 2018;26(5):1361-7. doi:10.1007/s00520-018-4090-8
- Maciel MG, Fruitg M, Lawall RP, Maciel AT. Characterization of antibiotic use, documented infection and prevalence of multidrug-resistant organisms in palliative care patients admitted to a private hospital in Brazil: A retrospective, cohort study. Indian J Palliat Care. 2021;27(4):530-7. doi:10.25259/IJPC_112_21
- Marra AR, Puig-Asensio M, Balkenende E, Livorsi DJ, Goto M, Perencevich EN. Antibiotic use during end-of-life care: A systematic literature review and meta-analysis. Infect Control Hosp Epidemiol. 2021;42(5):523-9. doi:10.1017/ice.2020.1241
- Moen MK, Løhre ET, Jakobsen G, Thronæs M, Klepstad P. Antibiotic therapy in integrated oncology and palliative cancer care: An observational study. Cancers (Basel). 2022;14(7):1602. doi:10.3390/cancers14071602
- Nanayakkara AK, Boucher HW, Fowler VG Jr, Jezek A, Outterson K, Greenberg DE. Antibiotic resistance in the patient with cancer: Escalating challenges and paths forward. CA Cancer J Clin. 2021;71(6):488-504. doi:10.3322/caac.21697
- Piezzi V, Wassilew N, Atkinson A, et al. Nosocomial outbreak of vancomycin-resistant Enterococcus faecium (VRE) ST796, Switzerland, 2017 to 2020. Euro Surveill. 2022;27(48):2200285. doi:10.2807/1560-7917.ES.2022.27.48.2200285
- Schmidt P, Hasan C, Mauritz MD, et al. Multidrug-resistant organisms in paediatric palliative care patients - Prevalence, risk factors and the impact of a liberal hygiene concept. J Paediatr Child Health. 2022;58(8):1352-8. doi:10.1111/jpc.15980
- Sirvain S, Durand M, Putot A, et al. Antibiotics in end of life: The driving factors. Infect Dis Now. 2022;52(3):175. doi:10.1016/j.idnow.2021.10.004
- Strapatsas TG, Simons V, Ghebremedhin B, Ahmad-Nejad P, Schmalz O. Prevalence of multidrug-resistant organisms on palliative care patients in a university hospital-bound palliative care unit: A prospective cohort analysis. Palliat Med. 2020;34(6):776-783. doi:10.1177/0269216320911591
- The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 13.1, 2023. http://www.eucast.org
- Thomas D, Kamalumpundi V, Thampi A, et al. Antibiotic stewardship in Indian palliative care: a single-center retrospective study. Antimicrob Steward Healthc Epidemiol. 2023;3(1):e196. doi:10.1017/ash.2023.468
- Wieland K, Chhatwal P, Vonberg RP. Nosocomial outbreaks caused by Acinetobacter baumannii and Pseudomonas aeruginosa: Results of a systematic review. Am J Infect Control. 2018;46(6):643-8. doi:10.1016/j.ajic.2017.12.014
PALYATİF SERVİS HASTALARININ ÇEŞİTLİ KLİNİK ÖRNEKLERİNDE ÜREYEN BAKTERİLER VE ANTİBİYOTİK DİRENÇ ORANLARI
Abstract
Palyatif servis hastalarında güncel enfeksiyon etkeni profilinin ve antibiyotik direnç paternlerinin bilinmesi kültür ve antibiyogram sonuçlarının belirlenmesine kadar başlanacak ampirik tedavi yönetimi açısından büyük öneme sahiptir. Çalışmamızda hastanemiz palyatif servisinde yatarak tedavi gören hastaların klinik örneklerinden izole edilen mikroorganizma dağılımının ve bu izolatların antibiyotik direnç profillerinin araştırılması amaçlanmıştır.
Bu çalışmada 2022-2023 yılları arasında Samsun Gazi Devlet Hastanesi palyatif servisinde yatan 264 hastanın mikrobiyoloji laboratuvarına gönderilen klinik örnekleri değerlendirildi.
Hastaların medyan yaşı 76 (aralık: 65-87) idi ve hastaların %41’i erkekti. En sık idrar yolu enfeksiyonu etkenleri Klebsiella spp. (%27.4) ve Escherichia coli (%27.4), en sık solunum yolu enfeksiyonu etkeni Acinetobacter baumannii (%36.7), en sık yara yeri enfeksiyonu etkeni Pseudomonas aeruginosa (%30) idi. En düşük direnç oranları Klebsiella izolatlarında seftazidim-avibaktam (%4.8) ve kolistine (%9.5); E. coli izolatlarında seftazidim-avibaktam (%0), kolistin (%0), imipenem (%7.1) ve meropeneme (%7.1); Acinetobacter izolatlarında kolistine (%0); Pseudomonas izolatlarımda kolistin (%0) ve seftazidim-avibaktama (%23.1); enterokok izolatlarında ise vankomisine (%0) karşı idi.
Çalışmamızdan elde edilen bulgular palyatif servis hastalarında idrar ve kan dolaşımı enfeksiyonu olgularına en sık Klebsiella ve E. coli’nin yol açtığını ve bu enfeksiyonlarda özellikle seftazidim-avibaktam ve kolistinin en etkili tedavi seçenekleri olduğunu, Acinetobacter ve Pseudomonas’ın etken olduğu olgularda da kolistinin en etkili antibiyotik olduğunu göstermiştir.
Keywords
Ethical Statement
Samsun Üniversitesi Klinik Araştırmalar Etik Kurulu, SÜKAEK -2023 17/22.
References
- Arkın FS, Cenger DH. Palyatif klinikte yatan kanser hastalarının kan kültürü sonuçlarının değerlendirilmesi. IKKSTD 2022;14(3):262-7. doi: 10.14744/iksstd.2022.99705
- Béziaud N, Pavese P, Barnoud D, Laval G. Infections bactériennes en soins palliatifs : antibiothérapies et limitations thérapeutiques [Bacterial infections in palliative care: antibiotics and therapeutic limitations]. Presse Med. 2009;38(6):935-44. doi:10.1016/j.lpm.2008.10.013
- Chen LK, Chou YC, Hsu PS, et al. Antibiotic prescription for fever episodes in hospice patients. Support Care Cancer. 2002;10(7):538-41. doi:10.1007/s00520-002-0377-9
- Clark MD, Halford Z, Herndon C, Middendorf E. Evaluation of antibiotic initiation tools in end-of-life care. Am J Hosp Palliat Care. 2022;39(3):274-81. doi:10.1177/10499091211027806
- Dagli O, Tasdemir E, Ulutasdemir N. Palliative care infections and antibiotic cost: a vicious circle. Aging Male. 2020;23(2):98-105. doi:10.1080/13685538.2019.1575353
- Durand M, Forestier E, Gras Aygon C, et al. Determinants of doctors' antibiotic prescriptions for patients over 75 years old in the terminal stage of palliative care. Infect Dis Now. 2021;51(4):340-5. doi:10.1016/j.medmal.2020.10.013
- Dyer J, Vaux L, Broom A, Broom J. Antimicrobial use in patients at the end of life in an Australian hospital. Infect Dis Health. 2019;24(2):92-7. doi:10.1016/j.idh.2018.12.001
- Garg VK, Mishra S, Gupta N, et al. Microbial and antibiotic susceptibility profile among isolates of clinical samples of cancer patients admitted in the intensive care unit at regional tertiary care cancer center: A retrospective observational study. Indian J Crit Care Med. 2019;23(2):67-72. doi:10.5005/jp-journals-10071-23119
- Hart E, Snape S, Thomson R. Palliative outpatient parenteral antibiotic therapy: a review of 5 years of patient data. JAC Antimicrob Resist. 2020;2(3):dlaa052. doi:10.1093/jacamr/dlaa052
- Henri B, Sirvain S, de Wazieres B, et al. Enquête de pratique sur les modalités de prescription des antibiotiques en phase terminale de soins palliatifs chez les patients de plus de 75 ans [Survey on antibiotic prescription practices for palliative care terminally ill patients of 75 years old and more]. Rev Med Interne. 2022;43(10):589-95. doi:10.1016/j.revmed.2022.08.011
- Hung KC, Lee LW, Liew YX, et al. Antibiotic stewardship program (ASP) in palliative care: antibiotics, to give or not to give. Eur J Clin Microbiol Infect Dis. 2022;41(1):29-36. doi:10.1007/s10096-021-04325-z
- Kim JH, Yoo SH, Keam B, Heo DS. Antibiotic prescription patterns during last days of hospitalized patients with advanced cancer: the role of palliative care consultation. J Antimicrob Chemother. 2023;78(7):1694-700. doi:10.1093/jac/dkad156
- Kim JH, Yoo SH, Keam B, Heo DS. The impact of palliative care consultation on reducing antibiotic overuse in hospitalized patients with terminal cancer at the end of life: a propensity score-weighting study. J Antimicrob Chemother. 2022;78(1):302-8. doi:10.1093/jac/dkac405
- Macedo F, Nunes C, Ladeira K, et al. Antimicrobial therapy in palliative care: an overview. Support Care Cancer. 2018;26(5):1361-7. doi:10.1007/s00520-018-4090-8
- Maciel MG, Fruitg M, Lawall RP, Maciel AT. Characterization of antibiotic use, documented infection and prevalence of multidrug-resistant organisms in palliative care patients admitted to a private hospital in Brazil: A retrospective, cohort study. Indian J Palliat Care. 2021;27(4):530-7. doi:10.25259/IJPC_112_21
- Marra AR, Puig-Asensio M, Balkenende E, Livorsi DJ, Goto M, Perencevich EN. Antibiotic use during end-of-life care: A systematic literature review and meta-analysis. Infect Control Hosp Epidemiol. 2021;42(5):523-9. doi:10.1017/ice.2020.1241
- Moen MK, Løhre ET, Jakobsen G, Thronæs M, Klepstad P. Antibiotic therapy in integrated oncology and palliative cancer care: An observational study. Cancers (Basel). 2022;14(7):1602. doi:10.3390/cancers14071602
- Nanayakkara AK, Boucher HW, Fowler VG Jr, Jezek A, Outterson K, Greenberg DE. Antibiotic resistance in the patient with cancer: Escalating challenges and paths forward. CA Cancer J Clin. 2021;71(6):488-504. doi:10.3322/caac.21697
- Piezzi V, Wassilew N, Atkinson A, et al. Nosocomial outbreak of vancomycin-resistant Enterococcus faecium (VRE) ST796, Switzerland, 2017 to 2020. Euro Surveill. 2022;27(48):2200285. doi:10.2807/1560-7917.ES.2022.27.48.2200285
- Schmidt P, Hasan C, Mauritz MD, et al. Multidrug-resistant organisms in paediatric palliative care patients - Prevalence, risk factors and the impact of a liberal hygiene concept. J Paediatr Child Health. 2022;58(8):1352-8. doi:10.1111/jpc.15980
- Sirvain S, Durand M, Putot A, et al. Antibiotics in end of life: The driving factors. Infect Dis Now. 2022;52(3):175. doi:10.1016/j.idnow.2021.10.004
- Strapatsas TG, Simons V, Ghebremedhin B, Ahmad-Nejad P, Schmalz O. Prevalence of multidrug-resistant organisms on palliative care patients in a university hospital-bound palliative care unit: A prospective cohort analysis. Palliat Med. 2020;34(6):776-783. doi:10.1177/0269216320911591
- The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 13.1, 2023. http://www.eucast.org
- Thomas D, Kamalumpundi V, Thampi A, et al. Antibiotic stewardship in Indian palliative care: a single-center retrospective study. Antimicrob Steward Healthc Epidemiol. 2023;3(1):e196. doi:10.1017/ash.2023.468
- Wieland K, Chhatwal P, Vonberg RP. Nosocomial outbreaks caused by Acinetobacter baumannii and Pseudomonas aeruginosa: Results of a systematic review. Am J Infect Control. 2018;46(6):643-8. doi:10.1016/j.ajic.2017.12.014
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Microbiology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | April 30, 2024 |
| Submission Date | December 17, 2023 |
| Acceptance Date | March 19, 2024 |
| Published in Issue | Year 2024 Volume: 38 Issue: 1 |
This work is licensed under a https://creativecommons.org/licenses/by-nc-nd/4.0/ license.