O uso de antibiótico em doentes que faleceram no hospital

Abstract

Introduction: The use of antibiotic until death is a common hospital practice for terminally ill patients at the end-of-life (EOL). However, in many cases, the effectiveness and benefit of this therapy are questionable, and the indiscriminate and improperly prolonged use of antibiotics in this population contributes to the emergence of multidrug-resistant bacteria (MDR). Objectives: The objective of this study was to determine the prevalence of antibiotic use in the last days of life for both patients with and without terminal illnesses in a hospital setting, including its class, duration, observed benefits, and the involvement of Palliative Care (PC) teams in the treatment. Method Embedded within a multicenter study, we conducted a longitudinal, retrospective, analytical, and observational study focused on the use of antibiotic therapy in 300 patients who died in the hospital, specifically in the Internal Medical Department (IMD) and the Intensive Care Department (ICU). Results: In both departments, 62.6% of deceased patients had terminal conditions associated with advanced chronic diseases. Among terminal patients who died, 55.3% received antibiotics until death, many of which had broadspectrum activity. In the IMD, terminal patients received fewer antibiotics than non-terminal patients (40.7% versus 56.8%), unlike the ICU where this relationship was similar (69.2% versus 75%). The average duration of antibiotic therapy was alike between terminal and non-terminal patients (5.2 and 5.6 days). A positive clinical response to treatment was documented in 12 patients. Consultation was requested from the PC team for 16 patients (5.3%). Approximately 70% of patients died with a Do Not Resuscitate (DNR) order in effect, of which 48.1% were under antibiotic therapy in the last days of life. The average duration of treatment was comparable between patients with and without DNR orders. A considerable number of EOL patients under DNR orders (26 patients in the SdM and 8 in the ICU) received antibiotics for an excessively prolonged period. Discussion and Conclusion: We observed a high prevalence of broad-spectrum antibiotic prescription in EOL patients, both in the IMD and the ICU. Furthermore, we observed an unnecessary extension in the administration of these antibiotics, despite the advanced state of the disease and the prior DNR decision made in this population. Notwithstanding potential underdocumentation in clinical records, the limited number of patients with clinical improvement raises doubts about the efficacy and benefits of antibiotic therapy in many EOL patients. VIII There was limited participation of the PC teams. A solution to mitigate the indiscriminate use of antibiotics in EOL patients, given their unique clinical and ethical contexts, lies in a specialized and patient-centered approach, which cannot be achieved without the active involvement of PC.

Date of Award	12 Dec 2023
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	João Gonçalves Pereira (Supervisor)