Jane Dyer1, Lucinda Vaux2, Alex Broom3, Jennifer Broom2. 1. Department of Medicine, Sunshine Coast Hospital and Health Service, Hospital Road, Nambour, QLD, 5470, Australia. Electronic address: jane.dyer@uqconnect.edu.au. 2. Department of Medicine, Sunshine Coast Hospital and Health Service, Hospital Road, Nambour, QLD, 5470, Australia. 3. School of Social Sciences, University of New South Wales, Sydney, NSW, 2052, Australia.
Abstract
BACKGROUND: Antimicrobial resistance is increasing and there is an urgent international imperative to optimise use within hospitals. Antibiotic use at the end of life is frequent in the hospital setting, but data on use in Australian hospitals in this context is limited, and optimisation is complicated by clinical/diagnostic, ethical and humanistic considerations. As yet there is little data available on baseline use in hospital end of life settings, an empirical gap we sought to begin to fill here. METHODS: A retrospective review of antibiotic use in patients who died in a Queensland hospital between January 2015 and July 2015. RESULTS: One hundred and thirty-seven patients were included, of which 73 were male (53.3%) and the median age was 81 years. Of these patients, 86 received antibiotics at the end of life. The most common antibiotic prescribed was piperacillin/tazobactam (41.9%). The most common site of infection was pulmonary (32.8%). Of 86 patients prescribed antibiotics, 29 patients (33.7%) received antibiotics after futility was documented. 83 patients (96.5%) were administered their antibiotics intravenously. CONCLUSION: Antimicrobial use at the end of life is frequent, with greater than one third of the patients who died in hospital having their antibiotics continued after discussion of futility. Antimicrobial use in this setting is complex with significant clinical, social and ethical considerations which need to be addressed if antibiotic optimization in this area (and more broadly in the hospital) is to be achieved. Crown
BACKGROUND: Antimicrobial resistance is increasing and there is an urgent international imperative to optimise use within hospitals. Antibiotic use at the end of life is frequent in the hospital setting, but data on use in Australian hospitals in this context is limited, and optimisation is complicated by clinical/diagnostic, ethical and humanistic considerations. As yet there is little data available on baseline use in hospital end of life settings, an empirical gap we sought to begin to fill here. METHODS: A retrospective review of antibiotic use in patients who died in a Queensland hospital between January 2015 and July 2015. RESULTS: One hundred and thirty-seven patients were included, of which 73 were male (53.3%) and the median age was 81 years. Of these patients, 86 received antibiotics at the end of life. The most common antibiotic prescribed was piperacillin/tazobactam (41.9%). The most common site of infection was pulmonary (32.8%). Of 86 patients prescribed antibiotics, 29 patients (33.7%) received antibiotics after futility was documented. 83 patients (96.5%) were administered their antibiotics intravenously. CONCLUSION: Antimicrobial use at the end of life is frequent, with greater than one third of the patients who died in hospital having their antibiotics continued after discussion of futility. Antimicrobial use in this setting is complex with significant clinical, social and ethical considerations which need to be addressed if antibiotic optimization in this area (and more broadly in the hospital) is to be achieved. Crown
Authors: Olivia S Kates; Elizabeth M Krantz; Juhye Lee; John Klaassen; Jessica Morris; Irina Mezheritsky; Ania Sweet; Frank Tverdek; Elizabeth T Loggers; Steven A Pergam; Catherine Liu Journal: Open Forum Infect Dis Date: 2021-08-02 Impact factor: 4.423