Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Oct;46(4):483-90.
doi: 10.1016/j.jpainsymman.2012.09.010. Epub 2013 Jan 11.

A nationwide analysis of antibiotic use in hospice care in the final week of life

Jennifer S Albrecht  1 , Jessina C McGregor, Erik K Fromme, David T Bearden, Jon P Furuno
Affiliations

A nationwide analysis of antibiotic use in hospice care in the final week of life

Jennifer S Albrecht et al. J Pain Symptom Manage. 2013 Oct.

Abstract

Context: Antibiotic prescription in hospice patients is complicated by the focus on palliative rather than curative care and concerns regarding increasing antibiotic resistance.

Objectives: 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.

Conclusion: 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.

Keywords: Hospice; NHHCS; antibiotics; infection.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Relationship between receiving antibiotics and having a documented infection among hospice discharges in the final week of care
Among 1,028 patients who received an antibiotic in the final 7 days of hospice care, only 129 (15%) had documentation of a potentially infection indication for antibiotic use.
See this image and copyright information in PMC

References

    1. National Hospice and Palliative Care Organization . NHPCO facts and figures: Hospice care in America. NHPCO; Alexandria, VA: Sep, 2010.
    1. Hospice Association of America . Hospice facts and statistics. Hospice Association of America; Washington, DC: Nov, 2010.
    1. Vitetta L, Kenner D, Sali A. Bacterial infections in terminally ill hospice patients. J Pain Symptom Manage. 2000;20(5):326–334. - PubMed
    1. Ford P, Fraser T, Davis M, Kodish E. Anti-infective therapy at the end of life: ethical decision-making in hospice-eligible patients. Bioethics. 2005;19(4):379–392. - PubMed
    1. Hutcheson A. Hospice care in the United States. Prim Care. 2011;38(2):173–182. - PubMed

Publication types

MeSH terms

Substances