Antibiotic Use In Patients Approaching End of Life – A Retrospective Review In A Tertiary Irish Hospital

Abstract Background Antibiotic prescribing at end of life is common in hospitals. Perceived benefits of antibiotic use must be balanced against the risk of potential patient harm and the wider implications of increasing antimicrobial resistance. We investigate antibiotic consumption and factors influencing their use during the last four weeks of life. Methods Deaths during the period between January – June 2023 in patients with a pre-existing ceiling of care were included. Antimicrobial use in the last four weeks of life was reviewed. Patient demographics, palliative care team input and antimicrobial choice, indication and duration, as well as microbiological results, were recorded. Factors associated with time from last antibiotic dose to time of death and with palliative consult were initially assessed using univariate analysis, with subsequent multivariate linear and logistic regression models used. Results N= 258 patients met eligibility criteria. N=234 (90.7%) received antimicrobials in the last four weeks of life, 86% in the last week of life and 44% within 24 hours before death. 86.32% of patients were over the age of 65, with an average age of 79. The average clinical frailty score was 5.22 and 6.38% were nursing home residents. 99% of therapy was intravenous and Piperacillin-tazobactam was the most common agent (n=178, 76%). 56% of patients had antimicrobial therapy escalated and 16% continued to receive antibiotics after transition to comfort-focused care. Palliative services were consulted in 168 cases, with palliative consult associated with younger age (p=0.003) and non-medical specialties (p=0.005). Increased antibiotic-free time prior to death was associated with palliative care consult (p=0.02) and increased length of stay (<0.0001), independent of age, infection team input, and multi-drug resistant organism carriage. Conclusion Antimicrobial use is common among patients approaching death. Palliative input influences prescribing behaviours. This study demonstrates the benefit of early palliative involvement in influencing antimicrobial choices at the end of life.