Moroni Matteo, Antonione Raffaella, Taddei Eleonora, Patil Luigi, Fantoni Massimo
Struttura Semplice Dipartimentale Cure Palliative Ravenna, 48022 Lugo di Romagna, Italy.
Rete Cure Palliative e Hospice Area Giuliana, Azienda Sanitaria Universitaria Giuliano-Isontina, 34129 Trieste, Italy.
Infez Med. 2025 Sep 1;33(3):284-293. doi: 10.53854/liim-3303-5. eCollection 2025.
Many patients receive antibiotics at the end of their lives: prudent use in this setting is essential to limit side effects and selective pressure. Evaluating benefits and harms of antibiotics in this context is complex, with many factors influencing final decisions, including transition to end-of-life care and diagnosis of impending death. We aimed to investigate attitudes towards antibiotic prescription among key specialists involved in end-of-life care, also as part of a consensus on antibiotic prescription at the end of life.
An anonymous ten-question survey was conducted in January 2025, over a one-month period, on the websites of the Italian Society of Infectious and Tropical Diseases (SIMIT), the Italian Society of Palliative Care (SICP), the Italian Society of General Practitioners (SIMG), and the Italian Federation of Associations of Internal Medicine Physicians (FADOI), with a denominator of 9224 potential respondents. Specialists were invited to respond questions about usual practice with both end-stage oncological and non-oncological patients. A descriptive analysis of the aggregated data was performed.
880 physicians (9.5% of the denominator) participated (59.2% female), most working in hospitals (56.7%) and internal medicine departments (39.9%). A plurality (40.8%) had less than 10 years of work experience. Attitudes towards infection management and antibiotic prescription varied widely. More than half of the respondents reported treating infections differently in oncological versus non-oncological patients. Only a minority used antibiotics to treat respiratory secretions. Most could not rely on institutional guidelines for antibiotic prescription in terminally ill patients.
The attitude towards antibiotic prescription at the end of life is influenced by many factors, including the physician's background and setting. Case-by-case decision-making and advanced care planning could be significantly supported by guidelines based on studies that provide real-life data and effectively stratify patients and scenarios.
许多患者在生命末期接受抗生素治疗：在此情况下谨慎使用抗生素对于限制副作用和选择性压力至关重要。在这种背景下评估抗生素的益处和危害很复杂，有许多因素影响最终决策，包括向临终关怀的过渡以及临近死亡的诊断。我们旨在调查参与临终关怀的关键专家对抗生素处方的态度，这也是临终抗生素处方共识的一部分。
2025年1月进行了一项为期一个月的匿名十题调查，调查在意大利传染病和热带病学会（SIMIT）、意大利姑息治疗学会（SICP）、意大利全科医生学会（SIMG）以及意大利内科医生协会联合会（FADOI）的网站上进行，潜在受访者有9224人。邀请专家回答有关终末期肿瘤患者和非肿瘤患者常规治疗的问题。对汇总数据进行了描述性分析。
880名医生（占分母的9.5%）参与了调查（59.2%为女性），大多数在医院工作（56.7%），在内科工作（39.9%）。多数（40.8%）工作经验不足10年。对感染管理和抗生素处方的态度差异很大。超过一半的受访者报告在肿瘤患者和非肿瘤患者中对感染的治疗方式不同。只有少数人使用抗生素治疗呼吸道分泌物。大多数人在为绝症患者开抗生素处方时无法依据机构指南。
临终时对抗生素处方的态度受许多因素影响，包括医生的背景和环境。基于提供真实生活数据并有效对患者和情况进行分层的研究制定的指南，可为逐案决策和高级护理规划提供有力支持。
