Antimicrobial Use in Patients on a Comfort Care Protocol: A Retrospective Cohort Study
Antimicrobial Use in Patients on a Comfort Care Protocol: A Retrospective Cohort Study
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DOI：
10.1089/jpm.2016.0094
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发表时间：
2016-11-01
影响因子：
2.8
通讯作者：
Pottinger, Paul S.
中科院分区：
文献类型：
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作者：
Merel, Susan E.;Meier, Cynthia A.;Pottinger, Paul S.
背景资料：抗菌药物常用于生命末期的患者，但舒适护理协议住院期间处方抗生素的患者百分比和预测因素尚不清楚。目的：确定急性护理环境中的患者在过渡到舒适护理时继续使用抗菌药物的频率，并描述与抗菌药物使用相关的患者特征。设计：2012年6月至2014年8月进行的回顾性队列研究。设置：两个相互关联的学术医疗中心。患者：>18岁的住院患者过渡到舒适护理方案。测量：舒适护理方案患者的抗菌药物给药。分析：我们生成描述性统计量，并使用修改后的泊松回归估计未经调整和调整的协会沿着与95%的置信区间（CI）和p-values.Results：有1881例患者纳入研究; 77%最终过渡到舒适护理方案的患者在入院期间接受了抗菌药物治疗，82%在医院死亡。在舒适护理订单后>= 24小时的711例存活患者中，111例（15.6%）仍在使用抗菌药物。调整年龄后，记录的感染与抗生素呈正相关（调整的相对风险[ARR] = 1.46，95%CI：1.00-2.12，p = 0.05）。内科和外科重症监护室（ICU）的患者比那些接受药物治疗的患者接受抗菌药物的可能性更小（MICU ARR=0.32，95% CI：0.14-0.72，p = 0.01; SICU/神经ARR= 0.32，95% CI：0.12-0.85，p = 0.02）。在接近生命终点的住院患者中，抗菌药物的使用相对较高，即使目标是舒适。
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.