Antimicrobial prescribing in patients with advanced-stage illness in the antimicrobial stewardship era

Yasuaki Tagashira, Kanae Kawahara, Akane Takamatsu, Hitoshi Honda

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)

Abstract

Objective Antimicrobials are frequently administered to patients with an advanced-stage illness. Understanding the current practice of antimicrobial use at the end of life and the factors influencing physicians' prescribing behavior is necessary to develop an effective antimicrobial stewardship program and to provide optimal end-of-life care for terminally ill patients.Design A 1-year retrospective cohort study.Setting A public tertiary-care center.Patients The study included 260 adult patients who were hospitalized and later died at the study institution with an advanced-stage illness.Results Of 260 patients in our study cohort, 192 (73.8%) had an advanced-stage malignancy and 136 (52.3%) received antimicrobial therapy in the last 14 days of their life; of the latter, 60 (44.1%) received antimicrobials for symptom relief. Overall antimicrobial use in the last 14 days of life was 421.9 days of therapy per 1,000 patient days. Factors associated with antimicrobial use in this period included a history of antimicrobial use prior to the last 14 days of life during index hospitalization (adjusted odds ratio [aOR], 4.86; 95% confidence interval [CI], 2.67-8.84) and antipyretic use in the last 14 days of life (aOR, 4.19; 95% CI, 2.01-8.71).Conclusion Approximately half of the patients hospitalized with an advanced-stage illness received antimicrobials in the last 14 days of life. The factors associated with antimicrobial use at the end of life in this study are likely to explain physicians' prescribing behaviors. In the current era of antimicrobial stewardship, reconsidering antimicrobial use in terminally ill patients is necessary.

Original languageEnglish
Pages (from-to)1023-1029
Number of pages7
JournalInfection Control and Hospital Epidemiology
Volume39
Issue number9
DOIs
Publication statusPublished - 01-09-2018
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Fingerprint

Dive into the research topics of 'Antimicrobial prescribing in patients with advanced-stage illness in the antimicrobial stewardship era'. Together they form a unique fingerprint.

Cite this