End-of-Life Antibiotherapy: Factors Associated With Prescription

Abstract

IntroductionMost cancer patients spend their last days of life in the hospital, often receiving invasive and non-palliative interventions. These patients are particularly susceptible to infections, which are a major cause of death. The decision to use antimicrobials in a palliative context is difficult, given the lack of guidelines. ObjectivesTo characterize patients who received antimicrobials at the end of life and analyze factors associated with their prescription decisions. MethodsA retrospective analysis of patients who died in the Medical Oncology Service from January to December 2017 was done. In addition, the use of antibiotics in the last 15 days of life was considered. Clinical, therapeutic, and Eastern Corporative Oncology Group Performance Status Scale (ECOG PS) variables were analyzed using SPSS v23. ResultsThere were a total of 116 deaths, of which 48.3% (n = 56) received antimicrobials in their last 15 days of life. The median age of the patients was 64.5 years. Most patients (55.4%) had an ECOG PS 4, of which 82.1% were stage IV tumors. The most frequent tumors were colorectal adenocarcinomas (21.3%), digestive noncolorectal (predominantly gastric or esophageal adenocarcinomas) (20.5%), and invasive breast carcinomas (16.4%). Asthenia (33.6%) and dyspnea (19.8%) were the main complaints, and most patients (55.4%) had respiratory infections. Fever was present in 51.8% of patients on antibiotics and was related to their use (p < 0.001). The use of antimicrobials is also related to higher C-reactive protein (CRP) values (p = 0.015). ConclusionsThe decision to institute antimicrobials at the end of life is related to clinical and analytical aspects suggestive of infection without considering the patient's general condition and the oncological disease's prognosis. Deprescription of antibiotic therapy is not yet a current clinical practice.

O manejo de infecções nos pacientes em cuidados paliativos em fase final de vida e processo ativo de morte

“…Há um debate em andamento sobre as indicações de antibióticos no final da vida (STIEL et al, 2012;MACEDO et al, 2018;MACIEL et al, 2021;CAMPOA et al, 2022) e ainda não existem diretrizes sobre administração de antimicrobianos nestas fases da doença em CP.…”