Exploring the Role of Antibiotics in Hospice Care

Abstract

Background: The decision regarding the use of antibiotics in hospice care, whether to initiate, defer, or discontinue therapy, presents challenges. This study aims to explore the characteristics of terminally ill patients associated with antimicrobial use in hospice.

Methods: Data are from a registry study enrolling patients admitted to hospice after discharge from a hospital. Three-hundred-sixty-six persons aged 18 and older were considered for the present analysis. Collected data encompassed demographic information, medical history, and outcomes assessed through a comprehensive geriatric assessment.

Results: Among the patients admitted to the hospice, 242 individuals did not receive antibiotics (Group A), and 91 (24.6%) were already undergoing antibiotic therapy at admission. Of these, 59 (65.6%) patients (Group B) continued the treatment, while 32 (35.6%; Group C) discontinued it. Additionally, 33 patients (Group D) initiated an antibiotic treatment during their hospice stay. Patients undergoing antibiotic therapy (Group D) presented higher residual functions than the other groups, especially compared to Group C (p<0.001). The four groups also differed in mortality risk. In particular, Cox proportional hazard models indicated that Group D presented a lower risk of death than Group A, even after adjustment for age, sex, estimated poor prognosis and two different performance status (PS ECOG, Karnofsky PS).

Conclusion: A relatively high number of persons admitted to the hospice receive antibiotic therapy without apparent benefit. The decision to prescribe antibiotics in hospice care appears to be based on the patient's functional performance and estimated prognosis.

Keywords: Hospice care; antibiotics; performance status; prognosis.