Use of antimicrobials in patients in Palliative Care admitted to the Intensive Care Unit: A retrospective study
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Abstract
Introduction: Palliative care (PC) improves the quality of life of patients and their families. The use of antimicrobials is controversial in PC patients, especially in those admitted to the intensive care unit (ICU). Objective: To evaluate the use of antimicrobials in PC patients admitted to the ICU. Methods: This is a retrospective study, performed from August 2019 to September 2020. Data on demographic profile, hospitalization, PC, and use of antimicrobials were collected from the Erasto Gaertner Hospital database, in Curitiba, Brazil. Results: 182 patients were studied, median age of 65 years and 52% men. The median length of stay in the ICU was 3 days; the median total length of stay in the hospital was 6 days and 89.5% of the patients died. The time in ICU of patients treated with antibiotics (14.8%) was significantly longer (p=0.033) than for patients who were not (85.2%). Using or not using antibiotics did not change the outcome. Among those who took antibiotics, death occurred in 81.5% of cases and among those who did not use, 74.8% died (p=0.627). Between the cases that used broad-spectrum antibiotics 17/19 (89.5%) died and the mean hospital stay was 16.2 days. Among cases that used narrow-spectrum 5/9 (62.5%) died and the mean hospital stay was 6.4 days (p=0.033). Conclusion: The administration and/or the spectrum of antibiotics in PC patients admitted to the ICU did not change the mortality rate. The administration of antibiotics increased the length of stay in the ICU.
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World Health Organization (WHO). Definition of palliative care. Available from: http://www.who.int/cancer/palliative/definition/en/
Juthani-Mehta M, Malani PN, Mitchell SL. Antimicrobials at the end of life: an opportunity to improve palliative care and infection management. JAMA. 2015;314(19):2017-8. https://doi.org/10.1001/jama.2015.13080
Mercadante S, Gregoretti C, Cortegiani A. Palliative care in intensive care units: why, where, what, who, when, how. BMC Anesthesiol. 2018;18(1):106. https://doi.org/10.1186/s12871-018-0574-9
Macedo F, Bonito N. Current opinion about antimicrobial therapy in palliative care: an update. Curr Opin Oncol. 2019;31(4):299-301. https://doi.org/10.1097/CCO.0000000000000514
Furuno JP, Noble BN, Horne KN, McGregor JC, Elman MR, Bearden DT, et al. Frequency of outpatient antibiotic prescription on discharge to hospice care. Antimicrob Agents Chemother. 2014;58(9):5473-7. https://doi.org/10.1128/AAC.02873-14
Lee SF. Antibiotics in palliative care: less can be more. Recognising overuse is easy. The real challenge is judicious prescribing. BMJ Support Palliat Care. 2018;8(2):187-188. https://doi.org/10.1136/bmjspcare-2017-001473
Mitchell SL, Shaffer ML, Loeb MB, Givens JL, Habtemariam D, Kiely DK, et al. Infection management and multidrug-resistant organisms in nursing home residents with advanced dementia. JAMA Intern Med. 2014;174(10):1660-7. https://doi.org/10.1001/jamainternmed.2014.3918
Burnham JP, Chi S, Ma J, Dans MC, Kollef MH. Reduction in antimicrobial use among medical intensive care unit patients during a cluster randomized crossover trial of palliative care consultation. Infect Control Hosp Epidemiol. 2019;40(4):491-2. https://doi.org/10.1017/ice.2019.34
Merel SE, Meier CA, McKinney CM, Pottinger PS. Antimicrobial use in patients on a comfort care protocol: a retrospective cohort study. J Palliat Med. 2016;19(11):1210-14. https://doi.org/10.1089/jpm.2016.0094
Rosenberg JH, Albrecht JS, Fromme EK, Noble BN, McGregor JC, Comer AC, et al. antimicrobial use for symptom management in patients receiving hospice and palliative care: a systematic review. J Palliat Med. 2013;16(12):1568-74. https://doi.org/10.1089/jpm.2013.0276
Givens JL, Jones RN, Shaffer ML, Kiely DK, Mitchell SL. Survival and comfort after treatment of pneumonia in advanced dementia. Arch Intern Med. 2010;170(13):1102-7. https://doi.org/10.1001/archinternmed.2010.181
Marra AR, Puig-Asensio M, Balkenende E, Livorsi DJ, Goto M, Perencevich EN. Antibiotic use during end-of-life care: A systematic literature review and meta-analysis. Infect Control Hosp Epidemiol. 2021;42(5):523-9. https://doi.org/10.1017/ice.2020.1241
Macedo F, Nunes C, Ladeira K, Pinho F, Saraiva N, Bonito N, et al. Antimicrobial therapy in palliative care: an overview. Support Care Cancer. 2018;26(5):1361-7. https://doi.org/10.1007/s00520-018-4090-8
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. https://doi.org/10.1016/0021-9681(87)90171-8
Stiel S, Krumm N, Pestinger M, Lindena G, Nauck F, Ostgathe C, et al. Antibiotics in palliative medicine--results from a prospective epidemiological investigation from the HOPE survey. Support Care Cancer. 2012;20(2):325-33. https://doi.org/10.1007/s00520-011-1084-1
Baghban A, Juthani-Mehta M. Antimicrobial Use at the End of Life. Infect Dis Clin North Am. 2017;31(4):639-647. https://doi.org/10.1016/j.idc.2017.07.009
Vitetta L, Kenner D, Sali A. Bacterial infections in terminally ill hospice patients. J Pain Symptom Manage. 2000;20(5):326-34. https://doi.org/10.1016/s0885-3924(00)00189-5
Helde-Frankling M, Bergqvist J, Bergman P, Björkhem-Bergman L. Antibiotic Treatment in End-of-Life Cancer Patients-A Retrospective Observational Study at a Palliative Care Center in Sweden. Cancers (Basel). 2016;8(9):84. https://doi.org/10.3390/cancers8090084
Waele JJ, Akova M, Antonelli M, Canton R, Carlet J, Backer D, et al. antimicrobial resistance and antibiotic stewardship programs in the ICU: insistence and persistence in the fight against resistance. A position statement from ESICM/ESCMID/WAAAR round table on multi-drug resistance. Intensive Care Med. 2018;44(2):189-96. https://doi.org/10.1007/s00134-017-5036-1
Datta R, Zhu M, Han L, Allore H, Quagliarello V, Juthani-Mehta M. Increased Length of Stay Associated with Antibiotic Use in Older Adults with Advanced Cancer Transitioned to Comfort Measures. Am J Hosp Palliat Care. 2020;37(1):27-33. https://doi.org/10.1177/1049909119855617
Shorr AF, Micek ST, Welch EC, Doherty JA, Reichley RM, Kollef MH. Inappropriate antibiotic therapy in Gram-negative sepsis increases hospital length of stay. Crit Care Med. 2011;39(1):46-51. https://doi.org/10.1097/CCM.0b013e3181fa41a7
Lam PT, Chan KS, Tse CY, Leung MW. Retrospective analysis of antibiotic use and survival in advanced cancer patients with infections. J Pain Symptom Manage. 2005;30(6):536-43. https://doi.org/10.1016/j.jpainsymman.2005.06.005
Marcus EL, Clarfield AM, Moses AE. Ethical issues relating to the use of antimicrobial therapy in older adults. Clin Infect Dis. 2001;33(10):1697-705. https://doi.org/10.1086/323757
Dyer J, Vaux L, Broom A, Broom J. Antimicrobial use in patients at the end of life in an Australian hospital. Infect Dis Health. 2019;24(2):92-7. https://doi.org/10.1016/j.idh.2018.12.001