接受姑息治疗咨询的患者的抗菌药物使用情况。
Antimicrobial use among patients receiving palliative care consultation.
作者信息
Chun Erin Diviney, Rodgers Phillip E, Vitale Caroline A, Collins Curtis D, Malani Preeti N
机构信息
Department of Internal Medicine, Division of Geriatric Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
出版信息
Am J Hosp Palliat Care. 2010 Jun;27(4):261-5. doi: 10.1177/1049909109352336. Epub 2009 Dec 3.
BACKGROUND
We sought to characterize antimicrobial use among patients receiving palliative care consultation.
METHODS
Retrospective review of patients seen by the Palliative Care Service at the University of Michigan Health System from January 2008 to May 2008.
RESULTS
Of 131 patients seen in consultation, 70 received antimicrobials. We identified 92 infections among these 70 patients; therapy for 54 (58.7%) was empiric. Empiric therapy was most commonly prescribed for respiratory infection and urinary tract infection. Piperacillin/tazobactam (P/T) was the most frequently used agent, with 26 patients receiving P/T (37.1%); 22 of 26 received this agent empirically (84.6%, P = .005). Vancomycin was prescribed to 23 patients (32.9%). Sixteen patients (22.9%) died in hospital; another 31 were enrolled in hospice care.
CONCLUSIONS
Our results suggest significant use of empiric, broad-spectrum antimicrobial therapy among hospitalized patients near the end of life. We advocate for careful assessment of potential benefits and treatment burdens of antimicrobial therapy, especially when palliation is the goal.
背景
我们试图描述接受姑息治疗咨询的患者的抗菌药物使用情况。
方法
对2008年1月至2008年5月在密歇根大学卫生系统姑息治疗服务处就诊的患者进行回顾性研究。
结果
在接受咨询的131例患者中，70例使用了抗菌药物。我们在这70例患者中发现了92例感染；54例（58.7%）的治疗为经验性治疗。经验性治疗最常用于呼吸道感染和尿路感染。哌拉西林/他唑巴坦（P/T）是最常用的药物，26例患者使用了P/T（37.1%）；26例中有22例经验性使用了该药物（84.6%，P = 0.005）。23例患者（32.9%）使用了万古霉素。16例患者（22.9%）在医院死亡；另外31例患者接受了临终关怀。
结论
我们的结果表明，在生命末期的住院患者中，经验性、广谱抗菌药物治疗的使用较为普遍。我们主张对抗菌药物治疗的潜在益处和治疗负担进行仔细评估，尤其是在以姑息治疗为目标时。
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