Antimicrobial prescribing in patients with advanced-stage illness in the antimicrobial stewardship era
Antimicrobial prescribing in patients with advanced-stage illness in the antimicrobial stewardship era
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DOI：
10.1017/ice.2018.167
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发表时间：
2018-09-01
影响因子：
4.5
通讯作者：
Honda, Hitoshi
中科院分区：
文献类型：
--
作者：
Tagashira, Yasuaki;Kawahara, Kanae;Honda, Hitoshi
目的：抗生素经常用于晚期疾病患者。了解目前在生命末期使用抗菌药物的做法和影响医生处方行为的因素，对于制定有效的抗菌药物管理计划和为绝症患者提供最佳的生命末期护理是必要的。设计：一项为期1年的回顾性队列研究。设置：一个公共三级护理中心。患者：该研究纳入了260名成年患者，他们因晚期疾病住院，后来在研究机构死亡。在我们研究队列的260例患者中，（73.8%）为晚期恶性肿瘤，（52.3%）在生命的最后14天内接受了抗菌药物治疗;后者中，60例（44.1%）接受了抗菌药物治疗以缓解症状。在生命的最后14天内，总体抗菌药物使用为每1,000患者日421.9天的治疗。在此期间，与抗菌药物使用相关的因素包括在生命的最后14天之前在索引住院期间的抗菌药物使用史（校正比值比[aOR]，4.86; 95%置信区间[CI]，2.67 - 8.84）和生命最后14天内使用解热药结论：大约一半的晚期疾病住院患者在生命的最后14天内接受了抗菌药物治疗。在这项研究中，与抗生素使用相关的因素可能会解释医生的处方行为。在当前的抗菌药物管理时代，有必要重新考虑在绝症患者中使用抗菌药物。
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.