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Antimicrobial prescribing in patients with advanced-stage illness in the antimicrobial stewardship era

Published online by Cambridge University Press:  02 August 2018

Yasuaki Tagashira ,
Kanae Kawahara ,
Akane Takamatsu  and
Hitoshi Honda
Yasuaki Tagashira
Affiliation:
Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
Kanae Kawahara
Affiliation:
Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
Akane Takamatsu
Affiliation:
Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
Hitoshi Honda*
Affiliation:
Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
*
Author for correspondence: Hitoshi Honda, MD, Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashidai, Fuchu, Tokyo, 183-8524, Japan. E-mail: hhhhonda@gmail.com
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Abstract

Objective

Antimicrobials are frequently administered to patients with an advanced-stage illness. Understanding the current practice of antimicrobial use at the end of life and the factors influencing physicians’ prescribing behavior is necessary to develop an effective antimicrobial stewardship program and to provide optimal end-of-life care for terminally ill patients.

Design

A 1-year retrospective cohort study.

Setting

A public tertiary-care center.

Patients

The study included 260 adult patients who were hospitalized and later died at the study institution with an advanced-stage illness.

Results

Of 260 patients in our study cohort, 192 (73.8%) had an advanced-stage malignancy and 136 (52.3%) received antimicrobial therapy in the last 14 days of their life; of the latter, 60 (44.1%) received antimicrobials for symptom relief. Overall antimicrobial use in the last 14 days of life was 421.9 days of therapy per 1,000 patient days. Factors associated with antimicrobial use in this period included a history of antimicrobial use prior to the last 14 days of life during index hospitalization (adjusted odds ratio [aOR], 4.86; 95% confidence interval [CI], 2.67–8.84) and antipyretic use in the last 14 days of life (aOR, 4.19; 95% CI, 2.01–8.71).

Conclusion

Approximately half of the patients hospitalized with an advanced-stage illness received antimicrobials in the last 14 days of life. The factors associated with antimicrobial use at the end of life in this study are likely to explain physicians’ prescribing behaviors. In the current era of antimicrobial stewardship, reconsidering antimicrobial use in terminally ill patients is necessary.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 9 , September 2018 , pp. 1023 - 1029
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Tagashira Y, et al. (2018). Antimicrobial prescribing in patients with advanced-stage illness in the antimicrobial stewardship era. Infection Control & Hospital Epidemiology 2018, 39, 1023–1029. doi: 10.1017/ice.2018.167

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