End-of-life use of antibiotics: a survey on how doctors decide

Crispim, Douglas Henrique; Silva, Ivaldo Olímpio Da; Carvalho, Ricardo Tavares de; Levin, Anna Sara Shafferman

doi:10.1016/j.ijid.2021.10.026

Cited by 8 publications

(2 citation statements)

References 30 publications

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“…Finally, in physician’s perspective, decide not to initiate antibiotics is tough when clinicians suspect infection in end-of-life clinical conditions. 4 Not initiate antibiotics become challenging in some infections, such as urinary tract infections, that may be more likely to improve symptomatically with antimicrobial therapy compared to other infections. 5 Studies that suggest this tendence did not use the same method to evaluate symptomatic improve.…”

Section: Dear Editormentioning

confidence: 99%

Comment on “Treatment of Positive Urine Cultures at End-of-Life and the Effect on Terminal Delirium Management”

Silva

2023

Am J Hosp Palliat Care

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Section: Dear Editormentioning

confidence: 99%

Comment on “Treatment of Positive Urine Cultures at End-of-Life and the Effect on Terminal Delirium Management”

Silva

2023

Am J Hosp Palliat Care

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“…10 Predictors of EOL antimicrobial use are multifactorial and may include: insufficient prescriber knowledge of benefits and risks, a desire to respect patient or surrogate decisions, and beliefs that antimicrobials are less invasive than other therapies or that they palliate symptoms. [11][12][13] To our knowledge, there is no high-level evidence to support antimicrobial use for relief of distressing symptoms, with the exception of pain secondary to urinary tract infection at EOL (prescriptive use poorly defined). 3,4,[14][15][16] Furthermore, when a patient's prognosis is estimated as weeks-to-months, there is little data to support survival benefits, 5,17 and conversely, continued use for those imminently dying may hasten death.…”

Section: Introductionmentioning

confidence: 99%

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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