title: A nationwide analysis of antibiotic use in hospice care in the final week of life.
abstract: BACKGROUND
  Antibiotic prescription in hospice patients is complicated by the focus on palliative rather than curative care and concerns regarding increasing antibiotic resistance.
  
  
  OBJECTIVE
  To estimate the antibiotic use in a national sample of hospice patients and identify facility and patient characteristics associated with antibiotic use in this population.
  
  
  METHODS
  This was an analysis of data from the 2007 National Home and Hospice Care Survey, a nationally representative sample of U.S. hospice agencies. We included data from 3884 patients who died in hospice care. The primary outcome measure was prevalence of antibiotic use in the last seven days of life. Diagnoses, including potential infectious indications for antibiotic use, were defined using International Classification of Diseases, Ninth Revision (ICD-9) codes. Chi-squared tests and t-tests were used to quantify associations of patient and facility characteristics with antibiotic use.
  
  
  RESULTS
  During the last seven days of life, 27% (95% CI: 24%-30%) of patients received at least one antibiotic and 1.3% (95% CI: 0.7%-2.0%) received three or more antibiotics. Among patients who received at least one antibiotic, 15% (95% CI: 10%-20%) had a documented infectious diagnosis compared with 9% (95% CI: 7%-11%), who had an infectious diagnosis but received no antibiotics.
  
  
  CONCLUSIONS
  In this nationally representative sample, 27% of hospice patients received an antibiotic during the last seven days of life, most without a documented infectious diagnosis. Further research is needed to elucidate the role of antibiotics in this patient population to maintain palliative care goals while reducing unnecessary antibiotic use.
authors: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors: Jennifer S
authors: JS
authors: Albrecht
authors: Jessina C
authors: JC
authors: McGregor
authors: Erik K
authors: EK
authors: Fromme
authors: David T
authors: DT
authors: Bearden
authors: Jon P
authors: JP
authors: Furuno
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000401:mortality* / Q000706:statistics & numerical data*; D014600:Utilization Review
chemical_list: D000900:Anti-Bacterial Agents
keywords: Hospice; NHHCS; antibiotics; infection