Antibiotic stewardship program (ASP) in palliative care: antibiotics, to give or not to give.

Autor: Hung KC; Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore., Lee LW; Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore., Liew YX; Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore., Krishna L; Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore., Chlebicki MP; Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore., Chung SJ; Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore., Kwa AL; Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore. andrea.kwa.l.h@sgh.com.sg.; Emerging Infectious Diseases, Duke-National University of Singapore Medical School, 8 College Rd, Singapore, 169857, Singapore. andrea.kwa.l.h@sgh.com.sg.; Singhealth Duke-NUS Medicine Academic Clinical Programme, 8 College Road, Level 4, Singapore, 169857, Singapore. andrea.kwa.l.h@sgh.com.sg.
Jazyk: angličtina
Zdroj: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology [Eur J Clin Microbiol Infect Dis] 2022 Jan; Vol. 41 (1), pp. 29-36. Date of Electronic Publication: 2021 Aug 20.
DOI: 10.1007/s10096-021-04325-z
Abstrakt: Antimicrobial therapy in terminally ill patients remains controversial as goals of care tend to be focused on optimizing comfort. International guidelines recommend for antibiotic stewardship program (ASP) involvement in antibiotic decisions in palliative patients. The primary objective was to evaluate the clinical impact of ASP interventions made to stop broad-spectrum intravenous antibiotics in terminally ill patients. This was a retrospective chart review of 459 terminally ill patients in Singapore General Hospital audited by ASP between December 2010 and December 2018. Antibiotic duration, time-to-terminal discharge for end-of-life care, time-to-mortality, and mortality rates of patients with antibiotics ceased or continued upon ASP recommendations were compared. A total of 283 and 176 antibiotic courses were ceased and continued post-intervention, respectively. The intervention acceptance rate was 61.7%. The 7-day mortality rate (47.3% vs 61.9%, p = 0.003) was lower in the ceased group, while 30-day mortality rate (76.0% vs 81.2%, p = 0.203) and time-to-mortality post-intervention (3 [0-24] vs 2 [0-27] days, p = 0.066) did not differ between the ceased and continued groups. After excluding the 57 patients who had antibiotics continued until death within 48 h of intervention, only time-to-mortality post-intervention was statistically significantly shorter in the ceased group (3 [0-24] vs 4 [0-27], p < 0.001). Of the 131 terminally discharged patients, antibiotic duration (4 [0-17] vs 6.5 [1-14] days, p = 0.001) and time-to-terminal discharge post-intervention (6 [0-74] vs 10.5 [3-63] days, p = 0.001) were shorter in the ceased group. Antibiotic cessation in terminally ill patients was safe, and was associated with a significantly shorter time-to-terminal discharge.
(© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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