Hospice & Palliative Care Buffalo, Buffalo, NY, USA.
Research Department, Hospice & Palliative Care Buffalo, Buffalo, NY, USA.
Am J Hosp Palliat Care. 2022 Sep;39(9):1014-1022. doi: 10.1177/10499091211057848. Epub 2021 Dec 10.
The decision to initiate antibiotics in hospice patients that are very near end-of-life is a complex ethical and stewardship decision. Antibiotics may be ordered to improve urinary tract infection-related symptoms, such as delirium. However, infection symptoms may be managed using antipsychotics, antipyretics, antispasmodics, and analgesics instead. Currently, there are no studies that compare symptom management between those who receive antibiotics and those who do not. A retrospective chart review was conducted for patients admitted to a hospice inpatient unit. Charts were included if the patient was admitted for delirium and had a Palliative Performance Scale score ≤40%, the urine culture was positive for organism growth, and the patient died while in the HIU. Clinical and demographic data was collected. Medication use was tallied for the 5 days prior to the date of death. Sixty-one charts met the inclusion criteria. Thirty-five patients received antibiotics (ABX+) and 26 did not (ABX-). There was no difference in any medication consumption between groups during the 5 days prior to death. The ABX+ group died 8.2 days after obtaining the urine sample vs 6 days ( =0.046). The ABX+ group had more documented urinary tract-specific infection symptoms (66% vs 38%, =0.042). More than half of antibiotic courses were discontinued prematurely. The results of this study do not show a difference in overall medication consumption between groups, which suggests that antibiotics may not help improve terminal delirium symptoms in those with a suspected urinary tract infection at end-of-life.
在生命末期临近的临终关怀患者中启动抗生素治疗是一个复杂的伦理和管理决策。抗生素可用于改善尿路感染相关症状，如意识混乱。然而，感染症状可以通过使用抗精神病药、退烧药、抗痉挛药和镇痛药来治疗。目前，没有研究比较接受抗生素治疗和不接受抗生素治疗的患者之间的症状管理。对入住临终关怀住院病房的患者进行了回顾性图表审查。如果患者因意识混乱入院，且姑息治疗表现量表评分≤40%，尿液培养阳性有微生物生长，且患者在 HIU 死亡，则纳入图表。收集临床和人口统计学数据。在死亡日期前的 5 天内计算药物使用情况。共有 61 份图表符合纳入标准。35 名患者接受了抗生素治疗（ABX+），26 名患者未接受抗生素治疗（ABX-）。在死亡前的 5 天内，两组之间任何药物的使用量均无差异。ABX+组在获得尿液样本后 8.2 天死亡，而 ABX-组为 6 天（=0.046）。ABX+组有更多记录的尿路感染特异性感染症状（66%对 38%，=0.042）。超过一半的抗生素疗程提前中断。本研究结果并未显示两组之间总体药物使用量存在差异，这表明抗生素可能无助于改善生命末期疑似尿路感染患者的终末期意识混乱症状。
