Background There is a paucity of research regarding the use of antibiotics in palliative care, particularly in the hospice setting. Many hospices rely on local hospital antibiotic guidelines which may not be appropriate. With a shift in the focus for palliative patients and concerns nationally regarding antibiotic resistance, it is crucial to review antibiotic usage in specialist palliative care.
Methods Patients commenced on antibiotics between 1 st September 2017 and 30th November 2017 at the hospice were included in the study. Patients admitted already receiving antibiotics or prescribed antibiotics by another service (e.g. in a hospital outpatient clinic) were not included. The notes and prescription chart of eligible patients were reviewed for details of antibiotic therapy and the subsequent patient outcomes.
Results A total of 11 patients were eligible for inclusion. The most common suspected source of infection in these patients was chest or urine (10 of the 11 patients). 3 patients received antibiotics intravenously. 2 patients were commenced on antibiotics based on positive specimen cultures, however all 11 patients had investigations to screen for infection, and 7 of the 11 had specimens sent for culture analysis. Only one patient was unable to complete the antibiotic course. Of the 11 patients receiving antibiotics, 5 died during their hospice admission. 4 of the 5 patients who died had received antibiotics within seven days.
Conclusions The patient numbers are small, and this may reflect low prescription rate of antibiotics in the hospice setting. 36% of the patients included died within 7 days of receiving antibiotics and this may indicate inappropriate prescription and misdiagnosis of the patient entering the dying phase. This study has not examined instances where antibiotic therapy was considered but not prescribed. Further studies with this scope are required to gain a more comprehensive view of antibiotic prescribing tendencies in the hospice setting.
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