CO34 | Inappropriate use of antibiotics in end-of-life patients: a single center retrospective study

L. Sala¹, G. Riggi¹, F. Dentali², D. Dalla Gasperina³ | ¹ASST dei Sette Laghi, Dipartimento di Area Medica, Varese, ²Università degli Studi dell’Insubria, Dipartimento di Medicina e Chirurgia, Varese, ³Università degli Studi dell’Insubria, Dipartimento di Medicina e Innovazione Tecnologica, Varese, Italy

Abstract

Premises and Purpose of the study: A 2023 report by WHO and ECDC has shown antimicrobial resistance as a threat to patients’(Pts) safety. The appropriate use of antibiotics in all healthcare settings is one of the tools to combat antibiotic resistance. Real-world data reporting antibiotic therapy (ATB) use in end-of-life Pts is limited.
Materials and Methods: A single-center observational retrospective cohort study was designed to investigate the antibiotic use of all end-of-life Pts admitted to the Internal Medicine Department of a tertiary care teaching Hospital in Northern Italy. Evaluated parameters: ATB in the last 72 and 24 hours of life, ATB under sedation, discontinuation of ATB, treatment variation, culture tests, empiric and targeted ATB.
Results: Between April and October ‘21, expected death occurred in 78 Pts (10.5% of all admitted Pts), 44 M, 33 F, median age 82.8 yrs (49-97), with an average hospitalization of 13.7 days. Palliative sedation was administered to 44 Pts (56%); the average duration was 21.8 hours. Urine and blood cultures were performed in 60% of Pts and 81% received empiric ATB. In 17% of cases ATB was changed from empiric to target in the last 72 hours. ATB was not interrupted in the last 72 hours in 56 Pts (71.8%) and in the last 24 hours in 44 Pts (56.4%); for 22 Pts (40%), antibiotics were administered until death.
Conclusions: Our study highlights the inappropriate use of antibiotics in end-of-life Pts with expected death. Improved knowledge of multidisciplinary end-of-life management should be encouraged within an antibiotic stewardship program.