Antibiotic therapy is associated with adverse drug events among older adults with advanced cancer: A cohort study.

Datta R, Han L, Doyle M, Allore H, Sanft T, Quagliarello V, Juthani-Mehta M. Antibiotic therapy is associated with adverse drug events among older adults with advanced cancer: A cohort study. Palliative Medicine. 2023 May 1; 37(5):793-798.

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Abstract:

BACKGROUND: Older adults with advanced cancer are exposed to antibiotics but estimates of adverse drug events associated with antibiotic therapy are lacking. AIM: Evaluate the association of antibiotic therapy with adverse drug events in older adults with advanced cancer. DESIGN: Cohort study where the exposure was the ratio of days of therapy of an oral or intravenous antibiotic per patient-day and the outcome was an adverse drug event, defined as cardiotoxicity, hepatotoxicity, nephrotoxicity, infection, or new detection of a multidrug-resistant organism. SETTING/PARTICIPANTS: Patients aged 65 years with solid tumors from a tertiary care center who received palliative chemotherapy ( = 914). RESULTS: Mean age was 75 ± 6.6 years, and 52% were female. Common tumors were lung (31%, = 284) and gastrointestinal (26%, = 234). Mean time from first course of palliative chemotherapy to index admission was 128 days. Five-hundred thirty (58%) patients were exposed to antibiotics during the index admission; of these, 27% ( = 143) met standardized criteria for infection. Patients were commonly exposed to cephalosporins (33%, = 298) and vancomycin (30%, = 276). Among patients exposed to antibiotics, 35% ( = 183/530) developed an adverse drug event. In multivariable testing, antibiotic therapy was associated with development of an adverse drug event ( > 0 to < 1 vs 0 days of therapy/patient-day: adjusted odds ratio [aOR] = 1.9; 95% confidence interval [CI], 1.2-2.8; 1 vs 0 days of therapy/patient-day: aOR = 2.1, 95% CI, 1.4-3.0). CONCLUSION: Antibiotic therapy was independently associated with adverse drug events in hospitalized older adults with advanced cancer. These findings may inform antibiotic decision-making among palliative care providers.