Burden and Management of Multidrug-Resistant Organisms in Palliative Care

Abstract

Palliative care includes comprehensive strategies to optimize quality of life for patients and families confronting terminal illness. Infections are a common complication in terminal illness, and infections due to multidrug-resistant organisms (MDROs) are particularly challenging to manage in palliative care. Limited data suggest that palliative care patients often harbor MDRO. When MDROs are present, distinguishing colonization from infection is challenging due to cognitive impairment or metastatic disease limiting symptom assessment and the lack of common signs of infection. Multidrug-resistant organisms also add psychological burden through infection prevention measures including patient isolation and contact precautions which conflict with the goals of palliation. Moreover, if antimicrobial therapy is indicated per goals of care discussions, available treatment options are often limited, invasive, expensive, or associated with adverse effects that burden patients and families. These issues raise important ethical considerations for managing and containing MDROs in the palliative care setting.

Keywords: MDRO; antimicrobial therapy; palliative care.

Figure 1.

Proposed infection management considerations according to strata of disease progression and goals of care. *Antimicrobial therapy may be indicated if perceived benefits outweigh the risks of antimicrobial therapy which include, among others, antibiotic-associated diarrhea, Clostridium difficile infection, nausea and vomiting, local skin and soft tissue irritation associated with peripheral intravenous lines, myelosuppression, neurotoxicity, and drug-drug interactions. Adapted from Hui et al.