临终时抗菌药物的使用与滥用：对治疗强化/限制计划的回顾性分析
Antimicrobial use and misuse at the end of life: a retrospective analysis of a treatment escalation/limitation plan.
作者信息
Wilder-Smith Adrian, Gillespie Thomas, Taylor D Robin
机构信息
College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
University Hospital Wishaw, NHS Lanarkshire, Wishaw, UK.
出版信息
J R Coll Physicians Edinb. 2019 Sep;49(3):188-192. doi: 10.4997/JRCPE.2019.304.
BACKGROUND
Antimicrobial treatment is common at end of life. A treatment escalation/limitation plan (TELP) offers the opportunity to avoid non-beneficial treatment in critically ill patients. Our aim was to evaluate antimicrobial prescribing in terminally ill patients, and assess whether it was modified using a TELP.
METHODS
Appropriateness of antimicrobial treatment was audited using a priori criteria in 94 consecutive hospital deaths. Prescribing in patients whose death was expected/unexpected, and who had a TELP with/without a 'ceiling' for antimicrobials, were compared.
RESULTS
Twenty three of 94 patients (24.5%) were receiving antimicrobials at time of death. This was not influenced by evidence of infection or whether death was expected. The use of a TELP (n = 81) with an antimicrobial 'ceiling' (28 with, 53 without) was associated with a significant reduction in antimicrobials administered (28.6% vs 81.1%; p < 0.0005).
CONCLUSIONS
Many complex factors contribute to antimicrobial misuse at end of life. An appropriately constructed TELP reduces inappropriate prescribing.
背景
抗菌治疗在生命末期很常见。治疗升级/限制计划（TELP）为避免对重症患者进行无益治疗提供了机会。我们的目的是评估晚期患者的抗菌药物处方，并评估是否使用TELP对其进行了调整。
方法
采用先验标准对94例连续住院死亡患者的抗菌治疗适宜性进行审核。比较了预期/意外死亡患者以及有/无抗菌药物“上限”的TELP患者的处方情况。
结果
94例患者中有23例（24.5%）在死亡时正在接受抗菌药物治疗。这不受感染证据或死亡是否预期的影响。使用带有抗菌药物“上限”的TELP（n = 81）（28例有，53例无）与使用抗菌药物的显著减少相关（28.6%对81.1%；p < 0.0005）。
结论
许多复杂因素导致生命末期抗菌药物的滥用。合理构建的TELP可减少不适当的处方。
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