Antibiotic use during end-of-life care: A systematic literature review and meta-analysis

Marra, Alexandre R.; Puig-Asensio, Mireia; Balkenende, Erin; Livorsi, Daniel J; Goto, Michihiko; Perencevich, Eli N.

doi:10.1017/ice.2020.1241

Cited by 16 publications

(19 citation statements)

References 88 publications

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“…The frequency in which antimicrobials were used at the EOL-59% in the last week of life and 5% on the day of death-was consistent with other studies. 2,4,7,24 Our findings provide a unique clinical picture of patients with cancer who more commonly receive antimicrobials at EOL: those more likely to be older, with clinical signs of infection, who receive diagnostic and radiologic testing, and those with higher rates of palliative care or infectious disease consultations. Other variables significantly associated with EOL antimicrobial use included the presence of an indwelling foreign device, mechanical ventilation, completed advance directives, orders for EOL care, and death in the ICU.…”

Section: Discussionmentioning

confidence: 87%

“…The majority of patients with cancer receive antimicrobials during terminal admissions, in palliative care units, and at the time surrounding death-even in the absence of infection. [1][2][3][4][5][6][7][8] In fact, one systematic review reported that more than 50% of patients with advanced cancer at the end of life (EOL) received antimicrobials (n = 15 studies). 2 Prophylactic and empiric antimicrobial use is common in cancer patients due to immunocompromised states and resultant non-specific signs of infection.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] In fact, one systematic review reported that more than 50% of patients with advanced cancer at the end of life (EOL) received antimicrobials (n = 15 studies). 2 Prophylactic and empiric antimicrobial use is common in cancer patients due to immunocompromised states and resultant non-specific signs of infection. Although antimicrobial stewardship programs (ASPs) identify EOL antimicrobial use as aggressive care, 9 appropriate practice guidelines are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Antimicrobial Use at the End-Of-Life Among Hospitalized Cancer Patients

Pandey

Wisniewski

Morjaria

et al. 2023

Am J Hosp Palliat Care

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Background: Antimicrobials are frequently administered at end-of-life (EOL) and their non-beneficial use may subject patients to unnecessary harms. Studies analyzing factors for antimicrobial prescribing in solid tumor cancer patients at the EOL are lacking. Thus, we aimed to identify factors and patterns associated with antimicrobial use in hospitalized adults with cancer at EOL. Methods: We used a retrospective cohort design to review electronic medical records of terminal hospitalized patients ≥18 years with solid tumors admitted to non-intensive care units in a metropolitan comprehensive cancer center during 2019 and assessed antimicrobial use in the last 7 days of life. Results: Among 633 cancer patients, 59% ( n = 376) received antimicrobials (AM+) within the last 7 days of life. AM + patients were older (P = .012), mostly of male gender (55%), and non-Hispanic ethnicity (87%). AM + patients were significantly more likely to have a foreign device, suspected signs of infection, neutropenia, positive blood culture result, documented advance directive; receive laboratory or radiologic testing, and a palliative care or infectious disease consultation (all P < .05). No statistically significant differences were observed in the presence of documented goals of care discussions, or EOL discussions/EOL care orders. Conclusion: Antimicrobial use at the EOL is common in solid tumor cancer patients at the EOL and is associated with increased utilization of invasive interventions. There is an opportunity for infectious disease specialists to build primary palliative care skills and partner with antimicrobial stewardship programs to better advise patients, decision makers, and primary teams on the use of antimicrobials at the EOL.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Antimicrobial Use at the End-Of-Life Among Hospitalized Cancer Patients

Pandey

Wisniewski

Morjaria

et al. 2023

Am J Hosp Palliat Care

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“…Acetaminophen was speculated to be used for pain management and for fever with infectious diseases. Antibiotics are commonly prescribed in the end-of-life stage for infectious diseases 31. Expectorants and tulobuterol (a β agonist) patch formulation were possibly prescribed due to the increased bronchial secretion towards the end-of-life stage, although the efficacy of these drugs to relieve respiratory secretion symptoms has not been shown 32.…”

Section: Discussionmentioning

confidence: 99%

Drug prescribing changes in the last year of life among homebound older adults: national retrospective cohort study

Hattori

Hamada

Yamanaka

et al. 2022

BMJ Support Palliat Care

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ObjectivesThis study aimed to evaluate the prescription patterns of drugs during the last year of life in homebound older adults who received home medical care.MethodsWe used a nationwide claims database in Japan and selected older adults aged ≥75 years who received home medical care services from ≥12 months before their death. We evaluated medications prescribed 12 months before death (month 12), 3 months before death (month 3) and in the last month of life (month 1). We explored the factors associated with the decreased number of cardiovascular preventive drugs from month 12 to both month 3 and month 1.ResultsA total of 118 661 participants were included, and the majority were aged ≥90 years and women. The prevalence of cardiovascular preventive drugs decreased but remained common in month 1, which included antihypertensives (34.7%), antiplatelets (15.9%), oral anticoagulants (7.6%), antidiabetic drugs (7.3%) and lipid-lowering drugs (6.1%). The relative decrease from month 12 to month 1 was the largest for lipid-lowering drugs (44.8%) and the smallest for oral anticoagulants (13.6%). Among other drugs, laxatives (enema), antiemetics, oral corticosteroids, analgesics, expectorants, bronchodilators and antibiotics showed a large relative increase. Older age, duration of home medical care services for <1 year and diagnoses of cancer, dementia and Parkinson’s disease were associated with a greater likelihood of a decreased number of cardiovascular preventive drugs.ConclusionsThere is room for deprescribing to avoid inappropriate polypharmacy by balancing preventive and symptom management drugs in those receiving home medical care with a limited life expectancy.

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“…Patients with advanced cancer are prone to infections due to cancer-treatment-induced immunosuppression, barrier dysfunctions, and the use of immunomodulating drugs like corticosteroids [ 9 ]. Antibiotic treatment in palliative care patients may not necessarily aim for, or result in, life prolongation, albeit some studies demonstrated an improved survival after the successful treatment of infections [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Therapy in Integrated Oncology and Palliative Cancer Care: An Observational Study

Moen

Løhre

Jakobsen

et al. 2022

Cancers

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Decision-making for antibiotic therapy in palliative cancer care implies avoiding futile interventions and to identify patients who benefit from treatment. We evaluated patient-reported outcome-measures (PROMs), physiological findings, and survival in palliative cancer care patients hospitalized with an infection. All acute admissions during one year, directly to a University Hospital unit that provided integrated services, were included. Serious infection was defined as a need to start intravenous antibiotics. PROMs, clinical and paraclinical variables, and survival were obtained. Sixty-two of 257 patients received intravenous antibiotic treatment. PROMs were generally similar in the infection group and the non-infection group, both in respect to intensities at admission and improvements during the stay. There were more physiological and paraclinical deviations at admission in patients in the infection group. These deviations improved during the stay. Survival was not poorer in the infection group compared to the non-infection group. Patients in integrated cancer care were as likely to be put on intravenous antibiotics but had longer survival. In integrated oncology and palliative cancer services, patients with an infection had similar outcomes as those without an infection. This argues that the use of intravenous antibiotics is appropriate in many patients admitted to palliative care.

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Antibiotic use during end-of-life care: A systematic literature review and meta-analysis

Cited by 16 publications

References 88 publications

Factors Associated with Antimicrobial Use at the End-Of-Life Among Hospitalized Cancer Patients

Factors Associated with Antimicrobial Use at the End-Of-Life Among Hospitalized Cancer Patients

Drug prescribing changes in the last year of life among homebound older adults: national retrospective cohort study

Antibiotic Therapy in Integrated Oncology and Palliative Cancer Care: An Observational Study

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