Antimicrobial Use in Patients on a Comfort Care Protocol: A Retrospective Cohort Study.

Journal of palliative medicine

PubMedID: 27309999

Merel SE, Meier CA, McKinney CM, Pottinger PS. Antimicrobial Use in Patients on a Comfort Care Protocol: A Retrospective Cohort Study. J Palliat Med. 2016;.
BACKGROUND
Antimicrobials are commonly used in patients near the end of life, but the percentage and predictors of patients prescribed antibiotics while hospitalized on a comfort care protocol are unknown.

OBJECTIVE
To determine how often patients in the acute care setting are continued on antimicrobials when they are transitioned to comfort-focused care and to describe patient characteristics correlated with antimicrobial use.

DESIGN
Retrospective cohort study conducted from June 2012 to August 2014.

SETTING
Two interrelated academic medical centers.

PATIENTS
Inpatients >18 years old transitioned to a comfort care protocol.

MEASUREMENTS
Administration of antimicrobials to patients on the comfort care protocol.

ANALYSIS
We generated descriptive statistics and used a modified Poisson regression to estimate unadjusted and adjusted associations along with 95% confidence intervals (CIs) and p-values.

RESULTS
There were 1881 patients included in the study; 77% of patients ultimately transitioned to a comfort care protocol received antimicrobials during their admission and 82% died in hospital. Of the 711 alive at =24 hours after comfort care orders, 111 (15.6%) were still on antimicrobials. After adjusting for age, a documented infection was positively associated with being on antibiotics (adjusted relative risk [ARR]?=?1.46, 95% CI: 1.00-2.12, p?=?0.05). Patients in the medical and surgical intensive care units (ICUs) were less likely than those on medicine to receive antimicrobials (MICU ARR?=?0.32, 95% CI: 0.14-0.72, p?=?0.01; SICU/Neuro ARR?=?0.32, 95% CI: 0.12-0.85, p?=?0.02).

CONCLUSIONS
Antimicrobial use is relatively high in hospitalized patients near the end of life, even when the goal is comfort.