Highlights
- •There is urgent imperative to optimise antimicrobial use due to increasing resistance.
- •Limited data is available on antimicrobial use in hospital end of life settings.
- •A retrospective study of antibiotic use in patients who died in an Australian hospital.
- •Finding of antibiotic continuation post futility discussion in one third of cases.
- •Clinical, ethical and social considerations complicate antimicrobial use in end of life.
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.
Keywords
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Article info
Publication history
Published online: January 14, 2019
Accepted:
December 16,
2018
Received in revised form:
December 14,
2018
Received:
September 28,
2018
Identification
Copyright
Crown Copyright © 2018 Published by Elsevier B.V. on behalf of Australasian College for Infection Prevention and Control. All rights reserved.
