Court séjour gériatrique, CH Alès Cévennes, Avenue du Docteur Jean Goubert, 30100 Alès, France.
Service de maladies infectieuses, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France.
Infect Dis Now. 2021 Jun;51(4):340-345. doi: 10.1016/j.medmal.2020.10.013. Epub 2020 Oct 16.
Notwithstanding high prevalence of presumably bacterial infections in elderly persons (EP) in palliative care (PC), there exists no recommendation on the role of antibiotic therapy (ABP) in this type of situation.
To describe the determinants of antibiotic prescription by general practitioners (GP) and by doctors practicing in institutions (DPI) for patients>75 years, in end-of-life situations in PC.
Descriptive investigation by anonymous self-administered questionnaire disseminated in France by e-mail.
A total of 301 questionnaires analyzed: 113 GP, 188 DPIs. The latter were mainly geriatricians (69, 36.6%) and infectologists/internists (41, 21.8%). Sixty-three (55,75%) GPs and 144 (78.7%) DPIs stated that they had prescribed antibiotics. Practice in "EHPAD" retirement homes or intensive care was often associated with non-prescription of antibiotics. Age, PC training and number of patients monitored bore no influence. Family involvement in decision-making was more frequent for GPs than for DPIs. The main purpose of antibiotic therapy was to relieve different symptoms (fever, respiratory congestion, functional urinary signs). Most of the doctors (81%) had previously encountered complications (allergy, adverse effect), which represented the main causes of treatment discontinuation.
Antibiotic use in end-of-life EPs in PC seems frequent. In accordance with the principle of beneficence, its goal of often symptom-related; that said, in the absence of scientific data, antibiotic prescription in end-of-life situations should be individualized in view of observing the other ethical caregiving principles (beneficence, non-maleficence, justice, patient autonomy) and re-evaluated daily.
尽管在姑息治疗（PC）的老年患者（EP）中，可能存在细菌感染的高发情况，但对于这种情况下抗生素治疗（ABP）的作用，目前尚无相关推荐。
描述在 PC 终末期情况下，全科医生（GP）和机构医生（DPI）为>75 岁患者开抗生素处方的决定因素。
通过匿名电子邮件在法国分发的自我管理问卷进行描述性调查。
共分析了 301 份问卷：113 份来自 GP，188 份来自 DPI。后者主要是老年病学家（69 人，36.6%）和感染病学家/内科医生（41 人，21.8%）。63 名（55.75%）GP 和 144 名（78.7%）DPI 表示他们开了抗生素处方。在“EHPAD”养老院或重症监护室的实践往往与不开抗生素相关。年龄、PC 培训和监测的患者数量没有影响。家庭参与决策对 GP 比 DPI 更为常见。抗生素治疗的主要目的是缓解不同的症状（发热、呼吸不畅、功能性尿症状）。大多数医生（81%）以前都遇到过并发症（过敏、不良反应），这是治疗中断的主要原因。
在 PC 的 EP 终末期使用抗生素似乎很常见。根据行善原则，其目标通常与症状相关；也就是说，在缺乏科学数据的情况下，应根据遵守其他伦理护理原则（行善、不伤害、公正、患者自主）个体化考虑终末期情况下的抗生素处方，并每天重新评估。
