Antimicrobial Use in Patients on a Comfort Care Protocol: A Retrospective Cohort Study.
Antimicrobials are commonly used in patients near the end of life, but the percentage and predictors of patients prescribed antibiotics while hospitalized on a comfort care protocol are unknown.



To determine how often patients in the acute care setting are continued on antimicrobials when they are transitioned to comfort-focused care and to describe patient characteristics correlated with antimicrobial use.



Retrospective cohort study conducted from June 2012 to August 2014.



Two interrelated academic medical centers.



Inpatients >18 years old transitioned to a comfort care protocol.



Administration of antimicrobials to patients on the comfort care protocol.



We generated descriptive statistics and used a modified Poisson regression to estimate unadjusted and adjusted associations along with 95% confidence intervals (CIs) and p-values.



There were 1881 patients included in the study; 77% of patients ultimately transitioned to a comfort care protocol received antimicrobials during their admission and 82% died in hospital. Of the 711 alive at ≥24 hours after comfort care orders, 111 (15.6%) were still on antimicrobials. After adjusting for age, a documented infection was positively associated with being on antibiotics (adjusted relative risk [ARR] = 1.46, 95% CI: 1.00-2.12, p = 0.05). Patients in the medical and surgical intensive care units (ICUs) were less likely than those on medicine to receive antimicrobials (MICU ARR = 0.32, 95% CI: 0.14-0.72, p = 0.01; SICU/Neuro ARR = 0.32, 95% CI: 0.12-0.85, p = 0.02).



Antimicrobial use is relatively high in hospitalized patients near the end of life, even when the goal is comfort.
1 Division of General Internal Medicine, Department of Medicine, University of Washington , Seattle, Washington.
Susan E
SE
Merel
2 Providence Hospice of Seattle , Seattle, Washington.
Cynthia A
CA
Meier
1 Division of General Internal Medicine, Department of Medicine, University of Washington , Seattle, Washington.|3 Department of Oral Health Sciences, University of Washington , Seattle, Washington.
Christy M
CM
McKinney
4 Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington , Seattle, Washington.
Paul S
PS
Pottinger
D000890:Anti-Infective Agents; D000971:Antineoplastic Combined Chemotherapy Protocols; D003561:Cytarabine; D005047:Etoposide; D006801:Humans; D007362:Intensive Care Units; D008727:Methotrexate; D010166:Palliative Care; D000070659:Patient Comfort; D012189:Retrospective Studies
D000890:Anti-Infective Agents; D003561:Cytarabine; D005047:Etoposide; D008727:Methotrexate