Infection Management in Palliative Care Patients

Review Article

Authors

DOI:

https://doi.org/10.5281/zenodo.10404255

Keywords:

Palliative Care,, Infection, , Cancer

Abstract

Palliative care encompasses multidisciplinary supportive treatments aimed at improving the quality of life for patients and their families in life-threatening situations. Palliative care patients are more prone to infections due to factors such as comorbidities, frequent hospital admissions, immunosuppressive conditions, and nutritional deficiencies. In palliative care patients, infections can manifest atypically, primarily related to cancer and the use of medications. In these patients, infections often involve resistant microorganisms due to prolonged hospital stays and frequent antibiotic use. Due to the fragile nature of palliative care patients, infections tend to result in high morbidity and mortality.In palliative care clinics, infections, prolonged hospitalizations, and increased costs perpetuate each other in a vicious cycle. The management of infections in palliative care patients requires a comprehensive evaluation of the individual patient. Timely initiation of treatment based on patient-specific assessments will significantly reduce morbidity, mortality, and costs. The aim of this study is to provide recommendations on how to approach infection management in palliative care patients.

References

World Health Organization.https://www.who.int/news-room/fact-sheets/detail/palliative-care, (Erişim tarihi: 07.06.2023)

Mayo Clinic.https://www.mayoclinic.org/tests-procedures/palliative-care/about/pac-20384637, (Erişim tarihi: 07.06.2023)

Bruera E, Higginson I, von Gunten CF, Morita T. Textbook of Palliative Medicine and Supportive Care, In: Navari RM, Green C, Haney ML, Roach NL. Infection in Palliative Care. Second Edition, CRP Press Taylor&Francis Group, 2015. pp. 789-2.

Nagy-Agren S, Haley H. Management of infections in palliative care patients with advanced cancer. J Pain Symptom Manage. 2002 Jul;24(1):64-70. doi: 10.1016/s0885-3924(02)00420-7. PMID: 12183096.

Mouton CP, Bazaldua OV, Pierce B, Espino DV. Common infections in older adults. Am Fam Physician. 2001 Jan 15;63(2):257-68. PMID: 11201692.

Pereira J, Watanabe S, Wolch G. A retrospective review of the frequency of infections and patterns of antibiotic utilization on a palliative care unit. J Pain Symptom Manage. 1998 Dec;16(6):374-81. doi: 10.1016/s0885-3924(98)00093-1. PMID: 9879162.

Sochor M. Léčba infekcí u pacientů v paliativní symptomatické a terminální fázi onkologického onemocnění [Management of infections in palliative and terminal cancer care]. Klin Onkol. 2013;26(5):323-30. Czech. doi: 10.14735/amko2013323. PMID: 24107154.

Vitetta L, Kenner D, Sali A. Bacterial infections in terminally ill hospice patients. J Pain Symptom Manage. 2000 Nov;20(5):326-34. doi: 10.1016/s0885-3924(00)00189-5. PMID: 11068154.

Dagli O, Tasdemir E, Ulutasdemir N. Palliative care infections and antibiotic cost: a vicious circle. Aging Male. 2020 Jun;23(2):98-105. doi: 10.1080/13685538.2019.1575353. Epub 2019 Mar 1. PMID: 30821574.

Abdel-Karim IA, Sammel RB, Prange MA. Causes of death at autopsy in an inpatient hospice program. J Palliat Med. 2007 Aug;10(4):894-8. doi: 10.1089/jpm.2006.0240. PMID: 17803410.

Homsi J, Walsh D, Panta R, Lagman R, Nelson KA, Longworth DL. Infectious complications of advanced cancer. Support Care Cancer. 2000 Nov;8(6):487-92. doi: 10.1007/s005200000143. PMID: 11094994.

Reinbolt RE, Shenk AM, White PH, Navari RM. Symptomatic treatment of infections in patients with advanced cancer receiving hospice care. J Pain Symptom Manage. 2005 Aug;30(2):175-82. doi: 10.1016/j.jpainsymman.2005.03.006. PMID: 16125033.

Chen LK, Chou YC, Hsu PS, et al. Antibiotic prescription for fever episodes in hospice patients. Support Care Cancer. 2002 Oct;10(7):538-41. doi: 10.1007/s00520-002-0377-9. Epub 2002 Aug 10. PMID: 12324808.

Lam PT, Chan KS, Tse CY, Leung MW. Retrospective analysis of antibiotic use and survival in advanced cancer patients with infections. J Pain Symptom Manage. 2005 Dec;30(6):536-43. doi: 10.1016/j.jpainsymman.2005.06.005. PMID: 16376740.

Mamak T, Hadiseh H, Shirin F, Masoud P, Mohammadreza S, Mahsa A. Antibiotic Treatment in End Stage Cancer Patients; Advantages and Disadvantages. Cancer Inform. 2023 Mar 29;22:11769351231161476. doi: 10.1177/11769351231161476. PMID: 37008074; PMCID: PMC10064464.

Lopez S, Vyas P, Malhotra P, et al. A Retrospective Study Analyzing the Lack of Symptom Benefit With Antimicrobials at the End of Life. Am J Hosp Palliat Care. 2021 Apr;38(4):391-395. doi: 10.1177/1049909120951748. Epub 2020 Aug 24. PMID: 32830525.

Abduh Al-Shaqi M, Alami AH, Zahrani AS, Al-Marshad B, Muammar AB, M Z AS. The pattern of antimicrobial use for palliative care in-patients during the last week of life. Am J Hosp Palliat Care. 2012 Feb;29(1):60-3. doi: 10.1177/1049909111406900. Epub 2011 Jun 15. PMID: 21676985.

Tagashira Y, Kawahara K, Takamatsu A, Honda H. Antimicrobial prescribing in patients with advanced-stage illness in the antimicrobial stewardship era. Infect Control Hosp Epidemiol. 2018 Sep;39(9):1023-1029. doi: 10.1017/ice.2018.167. Epub 2018 Aug 2. PMID: 30070197.

Oh DY, Kim JH, Kim DW, et al. Antibiotic use during the last days of life in cancer patients. Eur J Cancer Care (Engl). 2006 Mar;15(1):74-9. doi: 10.1111/j.1365-2354.2005.00603.x. PMID: 16441680.

White PH, Kuhlenschmidt HL, Vancura BG, Navari RM. Antimicrobial use in patients with advanced cancer receiving hospice care. J Pain Symptom Manage. 2003 May;25(5):438-43. doi: 10.1016/s0885-3924(03)00040-x. PMID: 12727041.

Juthani-Mehta M, Malani PN, Mitchell SL. Antimicrobials at the End of Life: An Opportunity to Improve Palliative Care and Infection Management. JAMA. 2015 Nov 17;314(19):2017-8. doi: 10.1001/jama.2015.13080. PMID: 26426830; PMCID: PMC4675049.

High KP, Bradley SF, Gravenstein S, et al. Infectious Diseases Society of America. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. J Am Geriatr Soc. 2009 Mar;57(3):375-94. doi: 10.1111/j.1532-5415.2009.02175.x. PMID: 19278394; PMCID: PMC7166905.

Liang SY. Sepsis and Other Infectious Disease Emergencies in the Elderly. Emerg Med Clin North Am. 2016 Aug;34(3):501-22. doi: 10.1016/j.emc.2016.04.005. PMID: 27475012; PMCID: PMC5022369.

Crossley, Kent B, and Phillip K. Peterson. Infections in the elderly. Clinical infectious diseases (1996): 209-214.

Özkök S, Cengiz M, Bağ Soytaş R, ve ark. Geriatri Kliniğinde Yatan Hastaların Enfeksiyon Özellikleri. Med Bull Haseki 2020;58:223-227.

Cagatay AA, Tufan F, Hindilerden F, et al. The causes of acute Fever requiring hospitalization in geriatric patients: comparison of infectious and noninfectious etiology. J Aging Res. 2010 Aug 12;2010:380892. doi: 10.4061/2010/380892. PMID: 21151521; PMCID: PMC2989655.

Tal S, Guller V, Gurevich A. Fever of unknown origin in older adults. Clin Geriatr Med. 2007 Aug;23(3):649-68, viii. doi: 10.1016/j.cger.2007.03.004. PMID: 17631239.

Avkan-Oguz V, Yapar N, Erdenizmenli M, et al. Effects of community-acquired infections on fever, leukocyte count and the length of stay in elderly. A cross-sectional study of 240 cases. Saudi Med J. 2006 Mar;27(3):368-72. PMID: 16532099.

Yahav D, Schlesinger A, Daitch V, et al. Presentation of infection in older patients--a prospective study. Ann Med. 2015 Jun;47(4):354-8. doi: 10.3109/07853890.2015.1019915. Epub 2015 Apr 9. PMID: 25856541.

Drieux L. Caractéristiques des infections respiratoires basses chez les sujets âgés [Characteristics of lower respiratory tract infections in the elderly]. Antibiotiques (Paris). 2010 Dec;12(4):190-196. French. doi: 10.1016/j.antib.2010.05.002. Epub 2010 Sep 25. PMID: 32288526; PMCID: PMC7146795.

Werner H, Kuntsche J. Infektionen im Alter--was ist anders? [Infection in the elderly--what is different?]. Z Gerontol Geriatr. 2000 Oct;33(5):350-6. German. doi: 10.1007/s003910070031. PMID: 11130188.

Wasserman M, Levinstein M, Keller E, Lee S, Yoshikawa TT. Utility of fever, white blood cells, and differential count in predicting bacterial infections in the elderly. J Am Geriatr Soc. 1989 Jun;37(6):537-43. doi: 10.1111/j.1532-5415.1989.tb05686.x. PMID: 2715561.

Magaziner J, Tenney JH, DeForge B, Hebel JR, Muncie HL Jr, Warren JW. Prevalence and characteristics of nursing home-acquired infections in the aged. J Am Geriatr Soc. 1991 Nov;39(11):1071-8. doi: 10.1111/j.1532-5415.1991.tb02871.x. PMID: 1753044.

Kurt H, Gündeş S, Geyik MF. Enfeksiyon Hastalıkları, Nobel Tıp Kitabevleri 2013 İstanbul.

Mouton CP, Bazaldua OV, Pierce B, Espino DV. Common infections in older adults. Am Fam Physician. 2001 Jan 15;63(2):257-68. PMID: 11201692.

Centers for Disease Control and Prevention. Guide to infection prevention for outpatient settings: minimum expectations for safe care. Atlanta: The Centers (2011).

Meyer KC. Lung infections and aging. Ageing Res Rev. 2004 Jan;3(1):55-67. doi: 10.1016/j.arr.2003.07.002. PMID: 15163102; PMCID: PMC7129100.

NHS England, https://www.england.nhs.uk/north- west/wpcontent/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf. (Erişim tarihi: 08.07.2023)

Royal United Hospital, https://www.ruh.nhs.uk/for_clinicians/departments_ruh/palliative_care/documents/palliative_care_handbook.pdf. (Erişim tarihi: 08.07.2023)

Tata Memorial Centre, https://tmc.gov.in/ncg/index.php/guidelines/palliative-care-guidelines. (Erişim tarihi: 08.07.2023)

Okamura JM, Miyagi JM, Terada K, Hokama Y. Potential clinical applications of C-reactive protein. J Clin Lab Anal. 1990;4(3):231-5. doi: 10.1002/jcla.1860040316. PMID: 2112596.

Póvoa P, Almeida E, Moreira P, et al. C-reactive protein as an indicator of sepsis. Intensive Care Med. 1998 Oct;24(10):1052-6. doi: 10.1007/s001340050715. PMID: 9840239.

Lisboa T, Seligman R, Diaz E, Rodriguez A, Teixeira PJ, Rello J. C-reactive protein correlates with bacterial load and appropriate antibiotic therapy in suspected ventilator-associated pneumonia. Crit Care Med. 2008 Jan;36(1):166-71. doi:10.1097/01.CCM.0000297886.32564.CF. PMID: 18007271.

Liu A, Bui T, Van Nguyen H, et al. Serum C-reactive protein as a biomarker for early detection of bacterial infection in the older patient. Age Ageing. 2010 Sep;39(5):559-65. doi: 10.1093/ageing/afq067. Epub 2010 Jun 23. PMID: 20573779.

Kieler M, Kössler P, Milovic M, et al. C-reactive protein and white blood cell count are adverse prognostic markers for patients with advanced cancer on parenteral nutrition in a palliative care unit setting: A retrospective cohort study. Palliat Med. 2022 Mar;36(3):540-548. doi: 10.1177/02692163211073939. Epub 2022 Feb 20. PMID: 35184630; PMCID: PMC8972954.

Allin KH, Nordestgaard BG. Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer. Crit Rev Clin Lab Sci. 2011 Jul-Aug;48(4):155-70. doi: 10.3109/10408363.2011.599831. PMID: 22035340.

Heikkilä K, Ebrahim S, Lawlor DA. A systematic review of the association between circulating concentrations of C reactive protein and cancer. J Epidemiol Community Health. 2007 Sep;61(9):824-33. doi: 10.1136/jech.2006.051292. PMID: 17699539; PMCID: PMC2703800.

Amano K, Maeda I, Morita T, et al. Clinical Implications of C-Reactive Protein as a Prognostic Marker in Advanced Cancer Patients in Palliative Care Settings. J Pain Symptom Manage. 2016 May;51(5):860-7. doi: 10.1016/j.jpainsymman.2015.11.025. Epub 2016 Jan 28. PMID: 26826676.

Marti L, Cervera C, Filella X, Marin JL, Almela M, Moreno A. Cytokine-release patterns in elderly patients with systemic inflammatory response syndrome. Gerontology. 2007;53(5):239-44. doi: 10.1159/000101436. Epub 2007 Mar 30. PMID: 17396033.

Zhang J, Zhang C, Li Q, et al. C-Reactive Protein/Albumin Ratio Is an Independent Prognostic Predictor of Survival in Advanced Cancer Patients Receiving Palliative Care. J Palliat Med. 2019 Dec;22(12):1536-1545. doi: 10.1089/jpm.2019.0102. Epub 2019 Jun 12. PMID: 31188054.

Goodrose-Flores C, Bonn S, Klasson C, et al. Appetite in Palliative Cancer Patients and Its Association with Albumin, CRP and Quality of Life in Men and Women-Cross-Sectional Data from the Palliative D-Study. Life (Basel). 2022 Apr 30;12(5):671. doi: 10.3390/life12050671. PMID: 35629338; PMCID: PMC9144128.

Simon L, Gauvin F, Amre DK, et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004 Jul 15;39(2):206-17. doi: 10.1086/421997. Epub 2004 Jul 2. Erratum in: Clin Infect Dis. 2005 May 1;40(9):1386-8. PMID: 15307030.

Ugarte H, Silva E, Mercan D, De Mendonça A, Vincent JL. Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med. 1999 Mar;27(3):498-504. doi: 10.1097/00003246-199903000-00024. PMID: 10199528.

Müller B, Becker KL, Schächinger H, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med. 2000 Apr;28(4):977-83. doi: 10.1097/00003246-200004000-00011. PMID: 10809269.

Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A. Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003 Jun;31(6):1737-41. doi: 10.1097/01.CCM.0000063440.19188.ED. PMID: 12794413.

Şen S, Kahveci K. Uzun süreli yoğun bakım ünitesi ve palyatif bakım merkezinde hastane enfeksiyonlarının sürveyansı; 3 yıllık analiz. Çağdaş Tıp Dergisi 8.1 (2018): 55-59.

Türk Hematoloji Derneği. https://thd.org.tr/THD_Halk/print.asp?sayfa=Kanserde_Enfeksiyondan_Korunma, (Erişim tarihi:25.07.2023)

Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010 Apr;31(4):319-26. doi: 10.1086/651091. PMID: 20156062.

O'Grady NP, Alexander M, Burns LA, et al. Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011 May;52(9):e162-93. doi: 10.1093/cid/cir257. Epub 2011 Apr 1. PMID: 21460264; PMCID: PMC3106269.

Siegel JD, Rhinehart E, Jackson M, Chiarello L. Health Care Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control. 2007 Dec;35(10 Suppl 2):S65-164. doi: 10.1016/j.ajic.2007.10.007. PMID: 18068815; PMCID: PMC7119119.

Published

2023-12-19

How to Cite

Bozkuş, R. (2023). Infection Management in Palliative Care Patients: Review Article. Europeanatolia Health Sciences Journal, 1(2), 75–86. https://doi.org/10.5281/zenodo.10404255