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Antibiotic use during end-of-life care: A systematic literature review and meta-analysis

Published online by Cambridge University Press:  11 November 2020

Alexandre R. Marra Open the ORCID record for Alexandre R. Marra [Opens in a new window] ,
Mireia Puig-Asensio ,
Erin Balkenende ,
Daniel J. Livorsi ,
Michihiko Goto  and
Eli N. Perencevich
Alexandre R. Marra*
Affiliation:
Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans’Affairs Health Care System, Iowa City, Iowa, United States University of Iowa Carver College of Medicine, Iowa City, Iowa, United States Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
Mireia Puig-Asensio
Affiliation:
Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans’Affairs Health Care System, Iowa City, Iowa, United States University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
Erin Balkenende
Affiliation:
Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans’Affairs Health Care System, Iowa City, Iowa, United States University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
Daniel J. Livorsi
Affiliation:
Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans’Affairs Health Care System, Iowa City, Iowa, United States University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
Michihiko Goto
Affiliation:
Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans’Affairs Health Care System, Iowa City, Iowa, United States University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
Eli N. Perencevich
Affiliation:
Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans’Affairs Health Care System, Iowa City, Iowa, United States University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
*
Author for correspondence: Alexandre R. Marra E-mail: alexandre-rodriguesmarra@uiowa.edu
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Abstract

Background:

We performed a systematic literature review and meta-analysis measuring the burden of antibiotic use during end-of-life (EOL) care.

Methods:

We searched PubMed, CINAHL (EBSCO platform), and Embase (Elsevier platform), through July 2019 for studies with the following inclusion criteria in the initial analysis: antibiotic use in the EOL care patients (advanced dementia, cancer, organ failure, frailty or multi-morbidity). If the number of patients in palliative care consultation (PCC) was available, antibiotic use data were pooled to compare the proportion of patients who received antibiotics under PCC compared to those not receiving PCC. Random-effect models were used to obtain pooled mean differences, and heterogeneity was assessed using the I2 value.

Results:

Overall, 72 studies met the inclusion criteria and were included in the final review: 22 EOL studies included only patients with cancer; 17 studies included only patients with advanced dementia; and 33 studies included “mixed populations” of EOL patients. Although few studies reported antibiotic using standard metrics (eg, days of therapy), 48 of 72 studies (66.7%) reported antibiotic use in >50% of all patients. When the 3 studies that evaluated antibiotic use in PCC were pooled together, patients under PCC was more likely to receive antibiotics compared to patients not under PCC (pooled odds ratio, 1.73; 95% CI, 1.02–2.93).

Conclusions:

Future studies are needed to evaluate the benefits and harms of using antibiotics for patients during EOL care in diverse patient populations.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 5 , May 2021 , pp. 523 - 529
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Appendices 1-2

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