Antibiotic stewardship program (ASP) in palliative care: antibiotics, to give or not to give
Antimicrobial therapy in terminally ill patients remains controversial as goals of care tend to be focused on optimizing comfort. International guidelines recommend for antibiotic stewardship program (ASP) involvement in antibiotic decisions in palliative patients. The primary objective was to evalu...
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| Veröffentlicht in: | European journal of clinical microbiology & infectious diseases 2022, Vol.41 (1), p.29-36 |
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| creator | Hung, Kai Chee Lee, Lai Wei Liew, Yi Xin Krishna, Lalit Chlebicki, Maciej Piotr Chung, Shimin Jasmine Kwa, Andrea Lay-Hoon |
| description | Antimicrobial therapy in terminally ill patients remains controversial as goals of care tend to be focused on optimizing comfort. International guidelines recommend for antibiotic stewardship program (ASP) involvement in antibiotic decisions in palliative patients. The primary objective was to evaluate the clinical impact of ASP interventions made to stop broad-spectrum intravenous antibiotics in terminally ill patients. This was a retrospective chart review of 459 terminally ill patients in Singapore General Hospital audited by ASP between December 2010 and December 2018. Antibiotic duration, time-to-terminal discharge for end-of-life care, time-to-mortality, and mortality rates of patients with antibiotics ceased or continued upon ASP recommendations were compared. A total of 283 and 176 antibiotic courses were ceased and continued post-intervention, respectively. The intervention acceptance rate was 61.7%. The 7-day mortality rate (47.3% vs 61.9%,
p
= 0.003) was lower in the ceased group, while 30-day mortality rate (76.0% vs 81.2%,
p
= 0.203) and time-to-mortality post-intervention (3 [0–24] vs 2 [0–27] days,
p
= 0.066) did not differ between the ceased and continued groups. After excluding the 57 patients who had antibiotics continued until death within 48 h of intervention, only time-to-mortality post-intervention was statistically significantly shorter in the ceased group (3 [0–24] vs 4 [0–27],
p
|
| doi_str_mv | 10.1007/s10096-021-04325-z |
| format | Article |
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p
= 0.003) was lower in the ceased group, while 30-day mortality rate (76.0% vs 81.2%,
p
= 0.203) and time-to-mortality post-intervention (3 [0–24] vs 2 [0–27] days,
p
= 0.066) did not differ between the ceased and continued groups. After excluding the 57 patients who had antibiotics continued until death within 48 h of intervention, only time-to-mortality post-intervention was statistically significantly shorter in the ceased group (3 [0–24] vs 4 [0–27],
p
< 0.001). Of the 131 terminally discharged patients, antibiotic duration (4 [0–17] vs 6.5 [1–14] days,
p
= 0.001) and time-to-terminal discharge post-intervention (6 [0–74] vs 10.5 [3–63] days,
p
= 0.001) were shorter in the ceased group. Antibiotic cessation in terminally ill patients was safe, and was associated with a significantly shorter time-to-terminal discharge.</description><identifier>ISSN: 0934-9723</identifier><identifier>EISSN: 1435-4373</identifier><identifier>DOI: 10.1007/s10096-021-04325-z</identifier><identifier>PMID: 34414518</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Antiinfectives and antibacterials ; Antimicrobial Stewardship ; Bacterial Infections - drug therapy ; Bacterial Infections - mortality ; Biomedical and Life Sciences ; Biomedicine ; End of life ; Female ; Hospitals, General ; Humans ; Internal Medicine ; Intervention ; Intravenous administration ; Length of Stay ; Male ; Medical Microbiology ; Middle Aged ; Mortality ; Original Article ; Palliation ; Palliative care ; Palliative Care - statistics & numerical data ; Patients ; Retrospective Studies ; Singapore ; Terminally Ill - statistics & numerical data ; Young Adult</subject><ispartof>European journal of clinical microbiology & infectious diseases, 2022, Vol.41 (1), p.29-36</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-9afc8aabfd23d494310a070b6dbe4aef8bb4644ac2b8bf8f6f95f1794780dcd63</citedby><cites>FETCH-LOGICAL-c375t-9afc8aabfd23d494310a070b6dbe4aef8bb4644ac2b8bf8f6f95f1794780dcd63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10096-021-04325-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10096-021-04325-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34414518$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hung, Kai Chee</creatorcontrib><creatorcontrib>Lee, Lai Wei</creatorcontrib><creatorcontrib>Liew, Yi Xin</creatorcontrib><creatorcontrib>Krishna, Lalit</creatorcontrib><creatorcontrib>Chlebicki, Maciej Piotr</creatorcontrib><creatorcontrib>Chung, Shimin Jasmine</creatorcontrib><creatorcontrib>Kwa, Andrea Lay-Hoon</creatorcontrib><title>Antibiotic stewardship program (ASP) in palliative care: antibiotics, to give or not to give</title><title>European journal of clinical microbiology & infectious diseases</title><addtitle>Eur J Clin Microbiol Infect Dis</addtitle><addtitle>Eur J Clin Microbiol Infect Dis</addtitle><description>Antimicrobial therapy in terminally ill patients remains controversial as goals of care tend to be focused on optimizing comfort. International guidelines recommend for antibiotic stewardship program (ASP) involvement in antibiotic decisions in palliative patients. The primary objective was to evaluate the clinical impact of ASP interventions made to stop broad-spectrum intravenous antibiotics in terminally ill patients. This was a retrospective chart review of 459 terminally ill patients in Singapore General Hospital audited by ASP between December 2010 and December 2018. Antibiotic duration, time-to-terminal discharge for end-of-life care, time-to-mortality, and mortality rates of patients with antibiotics ceased or continued upon ASP recommendations were compared. A total of 283 and 176 antibiotic courses were ceased and continued post-intervention, respectively. The intervention acceptance rate was 61.7%. The 7-day mortality rate (47.3% vs 61.9%,
p
= 0.003) was lower in the ceased group, while 30-day mortality rate (76.0% vs 81.2%,
p
= 0.203) and time-to-mortality post-intervention (3 [0–24] vs 2 [0–27] days,
p
= 0.066) did not differ between the ceased and continued groups. After excluding the 57 patients who had antibiotics continued until death within 48 h of intervention, only time-to-mortality post-intervention was statistically significantly shorter in the ceased group (3 [0–24] vs 4 [0–27],
p
< 0.001). Of the 131 terminally discharged patients, antibiotic duration (4 [0–17] vs 6.5 [1–14] days,
p
= 0.001) and time-to-terminal discharge post-intervention (6 [0–74] vs 10.5 [3–63] days,
p
= 0.001) were shorter in the ceased group. Antibiotic cessation in terminally ill patients was safe, and was associated with a significantly shorter time-to-terminal discharge.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Antiinfectives and antibacterials</subject><subject>Antimicrobial Stewardship</subject><subject>Bacterial Infections - drug therapy</subject><subject>Bacterial Infections - mortality</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>End of life</subject><subject>Female</subject><subject>Hospitals, General</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Intervention</subject><subject>Intravenous administration</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical Microbiology</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Original Article</subject><subject>Palliation</subject><subject>Palliative care</subject><subject>Palliative Care - statistics & numerical data</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Singapore</subject><subject>Terminally Ill - statistics & numerical data</subject><subject>Young Adult</subject><issn>0934-9723</issn><issn>1435-4373</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kEtLAzEYRYMotlb_gAsJuKngaF4zmXFXii8oKKg7ISQzSU2Zl8lUsb_e1D4EF24SwnfuzccB4BijC4wQv_ThzJIIERwhRkkcLXZAHzMaR4xyugv6KKMsyjihPXDg_QyFUMr5PuhRxjCLcdoHr6O6s8o2nc2h7_SndIV_sy1sXTN1soLD0dPjGbQ1bGVZWtnZDw1z6fQVlNugP4ddA6fLUeNg3XSb5yHYM7L0-mh9D8DLzfXz-C6aPNzej0eTKKc87qJMmjyVUpmC0IJljGIkEUcqKZRmUptUKZYwJnOiUmVSk5gsNphnjKeoyIuEDsBw1Ru2fp9r34nK-lyXpax1M_eCxAllhDK8RE__oLNm7uqwnSAJTngaxPBAkRWVu8Z7p41ona2k-xIYiaV7sXIvgnvx414sQuhkXT1XlS62kY3sANAV4MOonmr3-_c_td9ME4-N</recordid><startdate>2022</startdate><enddate>2022</enddate><creator>Hung, Kai Chee</creator><creator>Lee, Lai Wei</creator><creator>Liew, Yi Xin</creator><creator>Krishna, Lalit</creator><creator>Chlebicki, Maciej Piotr</creator><creator>Chung, Shimin Jasmine</creator><creator>Kwa, Andrea Lay-Hoon</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>2022</creationdate><title>Antibiotic stewardship program (ASP) in palliative care: antibiotics, to give or not to give</title><author>Hung, Kai Chee ; Lee, Lai Wei ; Liew, Yi Xin ; Krishna, Lalit ; Chlebicki, Maciej Piotr ; Chung, Shimin Jasmine ; Kwa, Andrea Lay-Hoon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-9afc8aabfd23d494310a070b6dbe4aef8bb4644ac2b8bf8f6f95f1794780dcd63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Antiinfectives and antibacterials</topic><topic>Antimicrobial Stewardship</topic><topic>Bacterial Infections - drug therapy</topic><topic>Bacterial Infections - mortality</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>End of life</topic><topic>Female</topic><topic>Hospitals, General</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Intervention</topic><topic>Intravenous administration</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical Microbiology</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Original Article</topic><topic>Palliation</topic><topic>Palliative care</topic><topic>Palliative Care - statistics & numerical data</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Singapore</topic><topic>Terminally Ill - statistics & numerical data</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hung, Kai Chee</creatorcontrib><creatorcontrib>Lee, Lai Wei</creatorcontrib><creatorcontrib>Liew, Yi Xin</creatorcontrib><creatorcontrib>Krishna, Lalit</creatorcontrib><creatorcontrib>Chlebicki, Maciej Piotr</creatorcontrib><creatorcontrib>Chung, Shimin Jasmine</creatorcontrib><creatorcontrib>Kwa, Andrea Lay-Hoon</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of clinical microbiology & infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hung, Kai Chee</au><au>Lee, Lai Wei</au><au>Liew, Yi Xin</au><au>Krishna, Lalit</au><au>Chlebicki, Maciej Piotr</au><au>Chung, Shimin Jasmine</au><au>Kwa, Andrea Lay-Hoon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antibiotic stewardship program (ASP) in palliative care: antibiotics, to give or not to give</atitle><jtitle>European journal of clinical microbiology & infectious diseases</jtitle><stitle>Eur J Clin Microbiol Infect Dis</stitle><addtitle>Eur J Clin Microbiol Infect Dis</addtitle><date>2022</date><risdate>2022</risdate><volume>41</volume><issue>1</issue><spage>29</spage><epage>36</epage><pages>29-36</pages><issn>0934-9723</issn><eissn>1435-4373</eissn><abstract>Antimicrobial therapy in terminally ill patients remains controversial as goals of care tend to be focused on optimizing comfort. International guidelines recommend for antibiotic stewardship program (ASP) involvement in antibiotic decisions in palliative patients. The primary objective was to evaluate the clinical impact of ASP interventions made to stop broad-spectrum intravenous antibiotics in terminally ill patients. This was a retrospective chart review of 459 terminally ill patients in Singapore General Hospital audited by ASP between December 2010 and December 2018. Antibiotic duration, time-to-terminal discharge for end-of-life care, time-to-mortality, and mortality rates of patients with antibiotics ceased or continued upon ASP recommendations were compared. A total of 283 and 176 antibiotic courses were ceased and continued post-intervention, respectively. The intervention acceptance rate was 61.7%. The 7-day mortality rate (47.3% vs 61.9%,
p
= 0.003) was lower in the ceased group, while 30-day mortality rate (76.0% vs 81.2%,
p
= 0.203) and time-to-mortality post-intervention (3 [0–24] vs 2 [0–27] days,
p
= 0.066) did not differ between the ceased and continued groups. After excluding the 57 patients who had antibiotics continued until death within 48 h of intervention, only time-to-mortality post-intervention was statistically significantly shorter in the ceased group (3 [0–24] vs 4 [0–27],
p
< 0.001). Of the 131 terminally discharged patients, antibiotic duration (4 [0–17] vs 6.5 [1–14] days,
p
= 0.001) and time-to-terminal discharge post-intervention (6 [0–74] vs 10.5 [3–63] days,
p
= 0.001) were shorter in the ceased group. Antibiotic cessation in terminally ill patients was safe, and was associated with a significantly shorter time-to-terminal discharge.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>34414518</pmid><doi>10.1007/s10096-021-04325-z</doi><tpages>8</tpages></addata></record> |
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| identifier | ISSN: 0934-9723 |
| ispartof | European journal of clinical microbiology & infectious diseases, 2022, Vol.41 (1), p.29-36 |
| issn | 0934-9723 1435-4373 |
| language | eng |
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| subjects | Adult Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Antibiotics Antiinfectives and antibacterials Antimicrobial Stewardship Bacterial Infections - drug therapy Bacterial Infections - mortality Biomedical and Life Sciences Biomedicine End of life Female Hospitals, General Humans Internal Medicine Intervention Intravenous administration Length of Stay Male Medical Microbiology Middle Aged Mortality Original Article Palliation Palliative care Palliative Care - statistics & numerical data Patients Retrospective Studies Singapore Terminally Ill - statistics & numerical data Young Adult |
| title | Antibiotic stewardship program (ASP) in palliative care: antibiotics, to give or not to give |
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