title: Antimicrobial use among patients receiving palliative care consultation.
abstract: BACKGROUND
  We sought to characterize antimicrobial use among patients receiving palliative care consultation.
  
  
  METHODS
  Retrospective review of patients seen by the Palliative Care Service at the University of Michigan Health System from January 2008 to May 2008.
  
  
  RESULTS
  Of 131 patients seen in consultation, 70 received antimicrobials. We identified 92 infections among these 70 patients; therapy for 54 (58.7%) was empiric. Empiric therapy was most commonly prescribed for respiratory infection and urinary tract infection. Piperacillin/tazobactam (P/T) was the most frequently used agent, with 26 patients receiving P/T (37.1%); 22 of 26 received this agent empirically (84.6%, P = .005). Vancomycin was prescribed to 23 patients (32.9%). Sixteen patients (22.9%) died in hospital; another 31 were enrolled in hospice care.
  
  
  CONCLUSIONS
  Our results suggest significant use of empiric, broad-spectrum antimicrobial therapy among hospitalized patients near the end of life. We advocate for careful assessment of potential benefits and treatment burdens of antimicrobial therapy, especially when palliation is the goal.
authors: Department of Internal Medicine, Division of Geriatric Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
authors: Erin Diviney
authors: ED
authors: Chun
authors: Phillip E
authors: PE
authors: Rodgers
authors: Caroline A
authors: CA
authors: Vitale
authors: Curtis D
authors: CD
authors: Collins
authors: Preeti N
authors: PN
authors: Malani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents; D003657:Decision Making / Q000941:ethics; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007239:Infections / Q000188:drug therapy*; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010166:Palliative Care / Q000941:ethics; D010397:Penicillanic Acid / Q000031:analogs & derivatives; D010865:Pilot Projects; D010878:Piperacillin; D000077725:Piperacillin, Tazobactam Drug Combination; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014640:Vancomycin
chemical_list: D000890:Anti-Infective Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D014640:Vancomycin; D010397:Penicillanic Acid; D010878:Piperacillin