Factors Associated with Antimicrobial Use at the End-Of-Life Among Hospitalized Cancer Patients.
Shila Pandey, Renee Wisniewski, Sejal Morjaria and 5 others
PMID 36812451WHAT IT FOUND
In 633 terminal solid tumor admissions, 59% received antimicrobials in the last week of life.
Nurses should expect this practice and ask whether each dose matches comfort goals, especially when devices, infection signs, or ICU care are present.
Key findings
01In 633 terminal solid tumor admissions, 376 (59%) received antimicrobials in the last 7 days of life, and 34 (5%) were newly prescribed on the day of death.
02Antimicrobial use was associated with older age, foreign devices, neutropenia, suspected signs of infection, positive blood cultures, more laboratory and imaging testing, infectious disease consultation, and death in the ICU.
03Documented goals of care discussions did not differ by antimicrobial use, even though the antimicrobial group had more do not resuscitate orders and health care proxy documentation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective chart review at one specialized cancer center, so it shows association, not cause. The records did not say why antimicrobials were prescribed, whether diagnostic testing came before or after antimicrobials, or whether antimicrobials were stopped before death. The study did not check whether goals of care notes actually discussed antimicrobials. It excluded blood cancers and transplant patients, so it does not apply to them. It did not limit the group to patients with suspected infection, so some antimicrobial use may have had other reasons. A formal end of life order set was not available for part of the year, so comfort-focused care may have been undercounted. Results may not generalize to hospitals without the same specialty services.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not conclude that antimicrobials were harmful or unnecessary. The study did not record why each antimicrobial was prescribed, whether it was stopped, or whether it changed comfort, so it cannot show that stopping them would help.