Background: Infections are common in terminally ill patients (pts), and although antibiotics are frequently prescribed, their benefit for symptom relief is not clear. Antimicrobials at the end of life (EOL) may increase the risk of antimicrobial resistance and Clostrioides difficile infection. Our aim was to determine the frequency of symptom occurrence at the EOL when comparing pts who did or did not receive antibiotics (AB+ or AB-). Methods: We reviewed electronic medical records of pts admitted to a palliative care unit of a quarternary care hospital between 01/09/2017 and 07/16/2017 and assessed antimicrobial use in the last 14 days of life. Differences in demographics and symptom control between AB+ and AB- pts were analyzed using chi-square analyses; p-values were computed using Mann-Whitney tests. Results: Of a total of 133 pts included, 90 (68%) received antimicrobials (AB+). The indication for antibiotics was documented in only 12% of pts. The AB+ and AB- groups were similar with respect to demographics, including sex, and Charleston Comorbidity Index except for age (p = 0.01) and race (p = 0.03). Documented infections were similar between AB+ and AB- groups, except urinary tract infections. No statistically significant differences were noted in documented symptoms including pain, dyspnea, fever, lethargy, and alteration of mental state or length of stay. Conclusion: Our study did not show differences in frequencies of documented symptoms with use of antimicrobials at EOL. Antimicrobial stewardship programs and further research can help with developing EOL care antimicrobial guidelines supporting patients and providers through shared decision-making.
BackgroundInfections are common in terminally ill patients, and although antibiotics are frequently prescribed, their benefit for symptom relief is not clear. Antimicrobials at the end of life (EOL) increase the risk of antimicrobial resistance and Clostridium difficile infection. Very few studies have described the risks and benefits of antimicrobials in patients at EOL. Here, we describe a retrospective chart review of antimicrobial use at EOL.MethodsWe reviewed electronic medical records of patients admitted in a palliative care unit of a tertiary care hospital between 2017 and 2018 and assessed antimicrobial use in the last 14 days of life. The analysis excluded neutropenic patients. Differences in demographics and symptom control between patients who did or did not receive antibiotics (AB+ or AB−) were analyzed using chi-square analyses; P-values were computed using Mann–Whitney tests.ResultsOf a total of 133 patients included, 89 (67%) received antimicrobials (AB+); however, the role of antibiotics was documented in only 12% of patients. The AB− and AB+ groups were similar with respect to demographics, including sex, and Charleston Comorbidity Index except for age (table). Documented infections were similar between AB− and AB+ groups, except urinary tract infections. No statistically significant differences were noted in documented symptoms including pain, dyspnea, fever, lethargy, and alteration of mental state or length of stay (LOS).ConclusionOur study did not show differences in frequencies of documented symptoms with use of antimicrobials at EOL. These results indicate that the risks of antimicrobial use may outweigh potential benefits and their use should be a part of goals of care discussions at EOL. Disclosures All authors: No reported disclosures.
BackgroundFever is a beneficial physiologic response to infection and is protective in gram-negative bacteremia and invasive candidiasis. Cooling blankets (CBs) are used in fevers due to a perception of providing symptomatic relief. However, external cooling of septic patients has been shown to be an independent risk factor for adverse effects. Here, we present a retrospective analysis of CB use in our institution and the associations of infections with CB duration.MethodsWe reviewed electronic medical records of patients aged ≥18 years admitted to a tertiary care hospital between 2015–2017 and in whom a CB was used. Study variables included demographics and clinical characteristics such as infection and fever duration (time of CB start to first defervescence). Correlations between continuous variables were assessed using the Spearman's rank correlation test and differences in the distribution of continuous variables by groups were assessed using Mann–Whitney U and Kruskal–Wallis tests.ResultsThis analysis included 548 patients who used a total of 575 CBs during their stay (27 patients used ≥1 CB). The median age was 61.9 years and 56.9% were male. The most frequent comorbidities were immunocompromised state (40.3%), diabetes mellitus (33.6%) and coronary artery disease (32.3%). Pneumonia was the most common infection within 5 days of CB start (31.9%). Only 174 CBs had a documented discontinuation during hospitalization; for the remaining CBs, such documentation was absent. The median CB duration for these patients was 33.8 hrs (IQR: 18.0–80.9) while median fever duration was only 21.8 hours (IQR: 6.6–52.2). CB duration was highly correlated with fever duration (rho=.773, pConclusionClinician documentation of CB use was poor, only 30.2% recorded a stop time. Documented CB duration exceeded fever duration by more than 1.5 times and led to shivering responses in over 2/3 of patients. These findings suggest that CB use is arbitrary, not in keeping with established protocol or rationale, and its adverse effects may outweigh potential benefits. Their role should be re-evaluated and appropriate institutional protocols formulated.Disclosures All authors: No reported disclosures.
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