According to the inclusion criteria, 100 end stage cancer patients including 56 males and 44 females were enrolled with a mean age of 59.8 years. 34% of the studied patients had esophageal and gastric cancer which more than half of them (58%) had a history of chemotherapy. 35 patients (35%) had received radiotherapy and 83 patients (83%) had a history of surgery. Microorganisms were found in only 29 patients (29%) and the most microorganism among the patients was E.coli (6%). (Table.1)
Table 1
|
Type of cancer
|
34 (34%)
|
Adenocarcinoma
|
9 (9%)
|
Squamous-cell carcinoma
|
6 (6%)
|
Sarcoma
|
7 (7%)
|
Breast cancer
|
10 (10%)
|
Colon Cancer
|
6 (6%)
|
Thyroid
|
2 (2%)
|
Spinal
|
6 (6%)
|
Ovarian cancer
|
4 (4%)
|
Pancreas
|
2 (2%)
|
AML
|
2 (2%)
|
Prostate
|
1 (1%)
|
Skull
|
1 (1%)
|
Jaw cancer
|
1 (1%)
|
Klatskin
|
1 (1%)
|
Lymphoma
|
1 (1%)
|
Liposarcoma
|
1 (1%)
|
Melanoma
|
1 (1%)
|
Pritoan
|
1 (1%)
|
Osteosarcoma
|
1 (1%)
|
Rectum
|
1 (1%)
|
Lung
|
1 (1%)
|
Sigmoid
|
1 (1%)
|
Metastatic Melanom
|
58 (58%)
|
History of chemotherapy
|
35 (35%)
|
History of radiotherapy
|
83 (83%)
|
History of surgery
|
29 (29%)
|
Microorganisms
|
Based on this study, the highest dose of antibiotics was related to Ceftriaxone (40.2%) and in the second place was Metronidazole (34.7%) and the lowest dose was related to Levofloxacin, Gentamycine and Colistine (1.4%). For 72% of patients, antibiotics were started at the beginning of hospitalization and for some patients antibiotics were modified based on culture results. For initiate, selective antibiotics were usually Ceftriaxone with Metronidazole or Ciprofloxacine with Clindamycine. Due to the length of hospitalization of some patients or intubation for some of them, patients subsequently developed ventilator-associated lung infection (VAP); especially in the case of ICU patients who developed resistant masses and started taking broad-spectrum antibiotics. Also for patients, according to the WHO standardization guide, the amount of antibiotic use, the standard amount of antibiotic consumption (Antimicrobial consumption Index) and the per capita consumption of antibiotics (Defined Daily Dose) were calculated.
About 78% of the patients had clinical symptoms, of which 21 patients (21%) complained of weakness and lethargy. 72 patients (72%) received antibiotics, which was less than the articles studied (91%). Fifty-one patients (71%) did not have any side effects due to antibiotics. The most common side effect of antibiotics among patients was skin rash (12.5%). (Table.2)
Table 2
Clinical symptoms and antibiotic side effects of patients
percentage
|
Frequency(n)
|
|
|
|
Clinical symptoms of patients
|
26.9%
|
21 (78)
|
Weakness and malaise
|
20.5%
|
16 (78)
|
Fever
|
24.5%
|
20 (78)
|
Respiratory problem
|
7.7%
|
6 (78)
|
Abdominal distension
|
9%
|
7 (78)
|
Abdominal pain
|
14.1%
|
11 (78)
|
Intubation
|
5.1%
|
4 (78)
|
Nausea and vomiting
|
7.8%
|
6 (78)
|
Loss of consciousness
|
6.4%
|
5 (78)
|
Cough
|
6.4%
|
5 (78)
|
Icter
|
|
|
Antibiotic side effects
|
16.7%
|
12 (72)
|
Rash and Urticaria
|
5.5%
|
4 (72)
|
Itching
|
5.5%
|
4 (72)
|
Diarrhea
|
5.5%
|
4 (72)
|
Nausea
|
1.4%
|
1 (72)
|
Vomiting
|
The blood culture included the following: Wound cultures included two cases of multidrug-resistant Pseudomonas-aeruginosa (MDR) and one case of carbapenem-resistant Klebsiella-pneumonia (KPC).
Positive trachea cultures included six cases of multidrug-resistant (MDR) Acinetobacter baumannii, two cases of imipenem-resistant Acinetobacter baumannii, one ampicillin-resistant Acinobacar bumani with intermediate sensitivity to amikacin, two cases of carbapenem-sensitive Klebsiella-pneumonia and one case of Enterobacter susceptible to Amipenem and Amikacin.
Seven positive blood cultures included two cases of imipenem-sensitive E-coli, Ampicillin-sulbactam and ceftriaxone resistant, two cases of linezolid-sensitive enterococcus faecalis, one case of enterobacteria sensitive to imipenem and amikacim, one case of methicillin-resistant coagulase-negative staphylococcus (MRSE) and one case of cotrimoxazole and ciprofloxacin sensitive Steno Trofomona Maltophilia.
Five positive urine cultures included one case of beta-lactamase-releasing ECOLI (ESBL), one case of E-COLI sensitive to ciprofloxacin, ampiculbactam and imipenem, one case of Enterococcus faecium sensitive to linezolid and two cases of imipenem sensitive Klebsiella-pneumonia.
In the case of liver mass culture, there was one case of imipenem and Ampicillin-sulbactam sensitive E.coli. One case of imipenem, amikacin and ceftazidime sensitive E.COLI was in the abdominal fluid culture. (Table.3)
Table 3
Characteristics of different types of microorganisms
Resistance
|
Sensitivity
|
Site of culture
|
percentage
|
frequency
|
|
-
|
-
|
-
|
71
|
71
|
No microorganisms
|
Ampicillin-sulbactam. Ciprofloxacin
|
Imipenem
|
Blood culture
|
2
|
2
|
E.coli
|
-
|
Esbl
|
Urine culture
|
1
|
1
|
E.coli
|
-
|
Ampicillin-sulbactam. Ciprofloxacin
|
Urine culture
|
1
|
1
|
E.coli
|
Ciprofloxacin
|
Imipenem. Ampicillin-sulbactam
|
Liver mass culture
|
1
|
1
|
E.coli
|
Ciprofloxacin
|
Imipenem. Amikacin. Ceftazidim
|
Abdominal fluid culture
|
1
|
1
|
E.coli
|
-
|
MDR
|
Trachea
|
6
|
6
|
Acintobacter.bomani
|
Imipenem
|
Ampicillin-sulbactam
|
Trachea
|
2
|
2
|
Acintobacter.bomani
|
Imipenem. Ampicillin-sulbactam
|
Intermediate Amikacin
|
Trachea
|
1
|
1
|
Acintobacter.bomani
|
-
|
MDR
|
Wound
|
2
|
2
|
Pseudomonasaeruginosa
|
Pipracilintazobactam. Ciprofloxacin
|
Imipenem
|
Trachea
|
2
|
2
|
Klebsiella-pneumonia
|
Imipenem(KPC)
|
colistine
|
Wound
|
1
|
1
|
Klebsiella-pneumonia
|
Pipracilintazobactam .Ciprofloxacin
|
Imipenem
|
Urine
|
2
|
2
|
Klebsiella-pneumonia
|
Vancomycine
|
Linezolide
|
Urine
|
1
|
1
|
Entrococusfaecium
|
Imipenem. Vancomycine
|
Linezolide
|
Blood
|
2
|
2
|
Entrococusfecalis
|
Cephoxitine
|
Vancomycine
|
Blood
|
1
|
1
|
Staphilococus Coagulasenegative
|
-
|
Imipenem.Amikacine
|
Blood
|
1
|
1
|
Entrobacter
|
-
|
Imipenem.Amikacine
|
Trachea
|
1
|
1
|
Entrobacter
|
-
|
Ciprofloxacin.Co-trimoxazole
|
Blood
|
1
|
1
|
Steno Trofomona Maltophilia
|
-
|
-
|
-
|
100
|
100
|
Total
|
The average estimated cost for antibiotic use was 7935540 Rials (24.4 dollars) (Table.4). It should be noted that in 1396, the average price of the dollar was 40422 Rials and in 1397, its average was 42000 Rials, which has been considered to calculate the average of the two, ie 41000 Rials.
Table 4
Costs related to antibiotics used by patients studied
|
Mean
|
Median
|
Maximum cost
|
Minimum cost
|
Antibiotic cost (Rials)
|
7935540
|
1000000
|
140000000
|
0
|
Antibiotic cost (Dollars)
|
193/5
|
24/4
|
3414/6
|
0
|
Twenty-three patients were hospitalized for 10 days. The daily cost of a bed in the normal ward is 1465000 Rials ($ 36). The daily cost of an ICU bed is 7342000 Rials ($ 179). The average cost of tests in the records of our patients is 4,000,000 Rials ($ 97). The cost of one cardiopulmonary resuscitation (CPR) was 1160000 Rials (28 dollars). Of course, the calculations of the above figures are related to the average prices in 1396-97.