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Unnecessary antibiotic prescriptions common upon discharge to hospice care
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Data published in Antimicrobial Agents and Chemotherapy suggest that 21% of patients discharged to hospice care were given an antibiotic prescription upon discharge. Among those, more than one-quarter did not have a documented infection during their hospital stay.
“The frequency and prevalence of antibiotic use in this patient population is a concern,” Jon Furuno, PhD, associate professor at the Oregon State University/Oregon Health & Science University College of Pharmacy, said in a press release. “Antibiotics themselves can have serious side effects that sometimes cause new problems, a factor that often isn’t adequately considered. And in terminally ill people, they may or may not work anyway.”
Jon Furuno
Furuno and colleagues conducted a cross-sectional study among adults discharged from Oregon Health & Science University to hospice care from 2010 to 2012. There were 62,792 discharges, of which 845 were discharges to hospice care. Sixty percent were discharged to home hospice care and 40% were discharged to inpatient hospice care.
Most patients were men aged at least 65 years who had been in the hospital for 7 days or fewer. Among the patients, 21.1% were discharged with an antibiotic prescription, but only 71.8% of those had a documented infection during the admission. The most common infections included bloodstream infections, septicemia or endocarditis (40.3%), pneumonia (38.9%) and urinary tract infections (36.3%).
Independent factors related to receiving an antibiotic prescription at discharge included having a documented infection during the admission (adjusted OR=7; 95% CI, 4.68-10.46), discharge to home hospice care (adjusted OR=2.86; 95% CI, 1.92-4.28) and having a cancer diagnosis (adjusted OR=2.19; 95% CI, 1.48-3.23).
“Given the uncertainty regarding the benefits and harms of antibiotic use in hospice care, these data are important as an initial step towards understanding which patients receive antibiotics and why,” the researchers wrote. “Further research should build on these data to clarify the role of antibiotic use in hospice care.”
Disclosure: The researchers have received research funding from Cubist Pharmaceuticals and Cambia Health Foundation. One researcher is a medical director of Gentiva Hospice.
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