Background In palliative care, 24–48hr antibiotic trials are prescribed in patients who have clinically changed and may be entering the last days of life(LDOL), but where infection is considered a possible reversible factor. Does this treatment benefit or burden patients?

Aim To determine the incidence of this in hospice practice, assess survival rates and identify common predictive factors of poor response.

Method Using SystmOne, a retrospective analysis of admissions to Marie Curie Hospice, Bradford Inpatient Unit between August-October 2018 was conducted. Data was collected for all inpatients starting antibiotics including diagnosis, OACC, details of antibiotic therapy, and admission outcome (discharge/death). Patients documented to be potentially entering LDOL when therapy was initiated were identified.

Results 78 patients were admitted, of which 40% (31/78)received antibiotics. Of those receiving antibiotics, 77% (24/31)had cancer and 25% (8/31)received multiple antibiotic courses. In 35% (11/31)cases, concerns the patient may be entering LDOL were documented when antibiotic therapy was initiated. Of these, 91% (10/11) died during the admission. Of those who died, all had cancer; the majority with metastatic disease(8/10), Karnofsky scores =40% (7/10), a ‘Deteriorating’(5/10) or ‘Unstable’(3/10) Phase of Illness and mean duration from antibiotic initiation to death was 5.4 days (range:1–12). In patients who received multiple antibiotic courses, 75%(6/8) died during admission.

Discussion Antibiotic use in this context appears relatively common and generally has a poor outcome, suggesting treatment could be an unnecessary burden for this patient group. Metastatic cancer, Karnofsky scores =40%, an ‘Unstable’ or ‘Deteriorating’ Phase of Illness and multiple antibiotics during admission may help predict a poor response.