Antimicrobial use among patients receiving palliative care consultation.
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.
Chun
Erin Diviney
ED
Department of Internal Medicine, Division of Geriatric Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Rodgers
Phillip E
PE
Vitale
Caroline A
CA
Collins
Curtis D
CD
Malani
Preeti N
PN
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
D000890:Anti-Infective Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D014640:Vancomycin; D010397:Penicillanic Acid; D010878:Piperacillin