Henri B, Sirvain S, de Wazieres B, Bernard L, Gavazzi G, Forestier E, Fraisse T
Post-urgences gériatriques, CHU Purpan, 31000 Toulouse, France.
Court séjour gériatrique, CH Alès-Cevennes, 811 avenue du Dr J goubert, 30100 Ales, France.
Rev Med Interne. 2022 Oct;43(10):589-595. doi: 10.1016/j.revmed.2022.08.011. Epub 2022 Sep 3.
Infections commonly occur terminally ill oldest patients in palliative care and questioned about antimicrobial use. The aim of this study was to describe practitioners' habits.
ancillary study on antibiotic modalities according to the setting of care from a national practices survey based on self administered questionnaire sent by e-mail in 2017.
220 practitioners/327 used antibiotic, 136 worked in hospital department (52 geriatricians), 20 nursing home and 64 general practitioners (GP). GP declared less palliative care patients (6/year). The antibiotic goal was symptomatic relief for 181 (82.3%) without statistically significant difference between groups. GP (25%) were the group that most collected patient opinion for antibiotic prescription. Nursing home (23%) and GP (18%) reported more urinary tract symptoms than others (11.7%) (P=0.003). Geriatricians (59.6%) declared significantly less urinary analysis than GP (90%) (P=0.0009). 212 doctor (96.4%) faced side effect (SI): more allergic reaction and less administration difficulties than the other groups. The stop decision was collegially took (156, 70,9%) significantly more in hospital (121, 89%) than in community (25, 39.1%) (P<0.001). Patient wishes were noted by 30 (46.96%) only GP.
Even if practice and number of patients follow up differ from each place of care, doctors' intention in antibiotic use respect palliative care goal to relieve discomfort. It is hard to diagnose infection and complementary exam are scarce. A repeated individualized evaluation with patient, his surrounding and his medical referent participation, is mandatory to give a constant adapted level of care in every place of care.
感染常见于临终关怀中病情最重的老年患者，并对抗菌药物的使用提出了质疑。本研究的目的是描述从业者的习惯。
根据2017年通过电子邮件发送的自我管理问卷进行的全国实践调查，对不同护理环境下的抗生素使用方式进行辅助研究。
220名从业者/327人使用了抗生素，136人在医院科室工作（52名老年病医生），20人在养老院工作，64人是全科医生（GP）。全科医生申报的姑息治疗患者较少（每年6例）。抗生素的目标是为181人（82.3%）缓解症状，各组之间无统计学显著差异。全科医生（25%）是最常收集患者对抗生素处方意见的群体。养老院（23%）和全科医生（18%）报告的尿路症状比其他群体（11.7%）更多（P=0.003）。老年病医生（59.6%）申报的尿液分析明显少于全科医生（90%）（P=0.0009）。212名医生（96.4%）面临副作用（SI）：过敏反应较多，给药困难少于其他组。停药决定由集体做出（156人，70.9%），在医院（121人，89%）明显多于社区（25人，39.1%）（P<0.001）。只有30名（46.96%）全科医生记录了患者的意愿。
即使不同护理场所的实践和患者随访数量不同，但医生使用抗生素的意图符合姑息治疗缓解不适的目标。感染难以诊断，辅助检查也很少。必须在患者、其周围人员和其医疗顾问的参与下进行反复的个体化评估，以便在每个护理场所提供持续适当的护理水平。
