The following is the summary of “Association of entry into hospice or palliative care consultation during acute care hospitalization with subsequent antibiotic utilization” published in the January 2023 issue of Clinical microbiology and infections by Marra, et al.
As such, researchers sought to estimate antibiotic use in the final 6 months of life for inpatients receiving hospice or palliative care and to identify prospective goals (i.e., time points) for antibiotic stewardship in this setting. Researchers analyzed data from a nationwide retrospective cohort study of Veterans Affairs (VA) patients who died in a VA hospital within 6 months prior to their death between January 1, 2014, and December 31, 2019. In addition, the VA’s consolidated electronic medical record was mined for information on inpatient and outpatient antibiotic usage, as well as patient demographics and co-morbidities.
Antibiotic use was compared between hospitalized patients assigned to palliative care or hospice and hospitalized patients not assigned to palliative care or hospice using a propensity score-matched cohort study. In the hospice and palliative care groups, there were 9,808 and 40,796 matched patient pairs, respectively. While 41% (4,040/9,808) of hospice patients and 48% (19,735/40,796) of palliative care patients received at least one antibiotic within 14 days of placement or consultation, only 25% (2,420/9,808) of matched nonhospice patients and 27% (10,991/40,796) of matched nonpalliative care patients received antibiotics.
Antibiotic prescriptions increased by 17% in the 14 days after entry into palliative care and by 12% in the 14 days after entry into hospice, both of which were inrelated toe increases. Researchers found that there was a disproportionately high exposure to antibiotics among patients admitted to the VA who were receiving palliative or hospice care, as well as among all patients who were nearing the end of life.