249. Frequency of Antimicrobial Complications following Initiation of Palliative Chemotherapy in Advanced Cancer Patients
Session: Poster Abstract Session: Antimicrobial Stewardship: Special Populations
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • IDWeek Abx Complications Poster RD 9.25.2018 FINAL.pdf (322.5 kB)
  • Background: Evaluating antimicrobial complications in advanced cancer patients on palliative chemotherapy may guide clinical care and stewardship efforts.

    Methods: We identified advanced cancer patients aged ≥ 65 years started on palliative chemotherapy from 1/2016 to 9/2017 at Yale New Haven Hospital.  Complications with and without antimicrobials were assessed during first hospitalizations until death or 3/2018. We compared differences with x2 tests. 

    Results: Of 2680 patients started on palliative chemotherapy, 1181 had ≥1 hospitalization.  Median age was 74 years (range 65-98), and 856 (72%) had solid tumors.  Median time to hospitalization from starting palliative chemotherapy was 77 days (range 1-580) and length of stay was 4 days (range 1-50). During first hospitalization, 158 (13%) died or were discharged to hospice.  Overall, 493 (42%) died. Palliative chemotherapy often included FOLFIRINOX (n=257), FOLFOX (n=239), or pembrolizumab (n=210).  During first hospitalizations, patients given antimicrobials more likely incurred nephrotoxicity, hepatotoxicity, or C. difficile infection within 7 days of use than patients not given antimicrobials (Table 1). 

    Conclusion: Antimicrobial complications are common in advanced cancer patients on palliative chemotherapy.  Increased stewardship and alignment of infection treatment with goals of care are needed.

    Table 1. Complications in palliative chemotherapy patients.

    Complication a

    Definition

    Antimicrobials (N=805)

    No Antimicrobials (N=376)

    P value

    Cardiotoxicity

    >60ms QTC rise

    QTC > 500ms

    83 (10%)

    35 (9%)

    .68

    Nephrotoxicity, mg/dL

    SCR ≥0.5 if Cr <3.0

    SCR ≥1.0 if Cr ≥3.0

    49 (6%)

    6 (2%)

    <.001

    Hematologic, /mm3 b

         Aplastic anemia

    Two of:

    ANC < 1,500

    Plt < 50,000

    Hg < 10

    9 (2%)

    4 (1%)

    .78

         Leukopenia

    ANC <1500

    10 (2%)

    4 (1%)

    .59

         Thrombocytopenia

    Plt < 100,000

    9 (2%)

    6 (2%)

    .79

    Hepatotoxicity, U/L

    ALT ≥ 102

    ALP ≥ 390

    88 (12%)

    26 (7%)

    .03

    Electrolyte, mEq/L

         Hypokalemia

    K < 3.0

    45 (6%)

    17 (5%)

    .49

         Hyperkalemia

    K > 5.5

    3 (0%)

    21 (6%)

    <.001

         Hypomagnesemia

    Mg < 1.2

    10 (1%)

    5 (1%)

    1.00

    Clostridium difficile

       

    Antigen +

    27 (3%)

    1 (0%)

    <.001

        

    Toxin +

    16 (2%)

    1 (0%)

    .02

    a Within 7 days of specified antimicrobials vs entire hospitalization in those not given antimicrobials

    b Solid tumor patients only: Antimicrobials N=538; No Antimicrobials N=318

     

    Rupak Datta, MD PhD1, Margaret Doyle, MPhil2, Vincent Quagliarello, MD, FIDSA1, Tara Sanft, MD3 and Manisha Juthani-Mehta, MD, FIDSA, FSHEA1, (1)Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, (2)Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT, (3)Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT

    Disclosures:

    R. Datta, None

    M. Doyle, None

    V. Quagliarello, None

    T. Sanft, None

    M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor , Consulting fee .

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