Hostname: page-component-77c89778f8-n9wrp Total loading time: 0 Render date: 2024-07-22T16:23:57.583Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of antibiotics among end-of-life hospitalized patients with advanced directives: Status examination and association with infectious disease consultation and physician burnout

Published online by Cambridge University Press:  28 August 2019

Rina Fedorowsky Open the ORCID record for Rina Fedorowsky [Opens in a new window] ,
Yaacov G. Bachner ,
Abraham Borer ,
Pnina Ciobotaro  and
Talma Kushnir
Rina Fedorowsky*
Affiliation:
Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheba, Israel Infection Control Unit, Rabin Medical Center, Hasharon Hospital, Petach Tikva, Israel
Yaacov G. Bachner
Affiliation:
Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheba, Israel
Abraham Borer
Affiliation:
Infection Control Unit, Soroka Medical Center, Beer-Sheba, Israel
Pnina Ciobotaro
Affiliation:
Infection Control Unit, Kaplan Medical Center, Rehovot, Israel
Talma Kushnir
Affiliation:
Department of Psychology, Ariel University, Ariel, Israel
*
Author for correspondence: Rina Fedorowsky MA, Rabin Medical Center, Hasharon Hospital, Infection Control Unit, Petakh Tikva 49372, Israel. Email: rinap@clalit.org.il or rinafedo@gmail.com.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Overuse of antibiotics in end-of-life patients with advanced directives increases bacterial resistance and causes morbidity and mortality. Consultations with infectious disease (ID) physicians and burnout, which can affect antibiotic days of therapy (DOT) prescribed by physicians, have not been examined so far.

Objectives:

To assess antibiotic use by physicians in end-of-life (EOL) patients with advanced directives and to investigate the association between ID consultations, physician burnout, and antibiotic DOT in those patients.

Design:

A descriptive correlational study.

Setting:

Acute-care and post–acute-care hospitals.

Participants:

The study included 213 physicians and 932 their hospitalized patients in the last 2 weeks of life

Methods:

We distributed questionnaires and analyzed the data collected regarding ID consultation, EOL antibiotics prescription with and without an advanced directive, and physician burnout to 278 physicians, and 213 were completed (response rate 76%).

Results:

Of the 932 deaths, 435 of 664 (>50%) were EOL patients with advanced directives. Of these patients, 74% received antibiotics, 29.9% had bacterial resistance cultures, and antibiotics were discontinued in only 5%. Half of the physicians lacked knowledge concerning antibiotics use issues and had significantly fewer consultations with ID physicians in EOL patients with advanced directives (mean rate, 0.27) than those without advanced directives (mean rate, 0.47). ID physicians reported significantly higher emotional exhaustion levels (mean rate, 29) than other medical specialties (mean rate, 19.2). Antibiotic DOT was significantly higher when patients had ID consultations (mean rate, 21.6) than in patients who did not (mean rate, 16.2). In post–acute-care hospitals and/or geriatric wards, antibiotic DOT was significantly higher than in other types of hospitals and/or wards. Depersonalization level was negatively related to antibiotic DOT (P < .05).

Conclusions:

Antibiotics are overused in EOL patients with advanced directives. ID physician burnout and impact of ID consultation should be further assessed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 11 , November 2019 , pp. 1222 - 1228
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albrecht, JS, McGregor, JC, Fromme, EK, Bearden, DT, Furuno, JP. A nationwide analysis of antibiotic use in hospice care in the final week of life. J Pain Symptom Manage 2013;46:483–490.CrossRefGoogle ScholarPubMed
Thompson, AJ, Silveira, MJ, Vitale, CA, Malani, PN. Antimicrobial use at the end of life among hospitalized patients with advanced cancer. Am J Hosp Palliat Care 2012;29:599–603.10.1177/1049909111432625CrossRefGoogle ScholarPubMed
Oh, DY, Kim, JH, Kim, DW, et al. Antibiotic use during the last days of life in cancer patients. Eur J Cancer Care 2006;15:74–79.CrossRefGoogle ScholarPubMed
D’Agata, E, Mitchell, SL. Patterns of antimicrobial use among nursing home residents with advanced dementia. Arch Intern Med 2008;25;168:357–362.CrossRefGoogle Scholar
Morrison, RS, Ahronheim, JC, Morrison, GR, et al. Pain and discomfort associated with common hospital procedures and experiences. J Pain Symptom Manag 1998;15:91–101.10.1016/S0885-3924(97)00261-3CrossRefGoogle ScholarPubMed
Granowitz, EV, Brown, RB. Antibiotic adverse reactions and drug interactions. Crit Care Clin 2008;24:421–442.CrossRefGoogle ScholarPubMed
Chun, ED, Rodgers, PE, Vitale, CA, Collins, CD, Malani, PN. Antimicrobial use among patients receiving palliative care consultation. Am J Hosp Palliat Care 2010;27:261–265.10.1177/1049909109352336CrossRefGoogle ScholarPubMed
Alonso, A, Ebert, AD, Dörr, D, Buchheidt, D, Hennerici, MG, Szabo, K. End-of-life decisions in acute stroke patients: an observational cohort study. BMC Palliat Care. 2016;15:38.10.1186/s12904-016-0113-8CrossRefGoogle Scholar
Phua, J, Kee, AC, Tan, A, et al. End-of-life care in the general wards of a Singaporean hospital: an Asian perspective. J Palliat Med 2011;14:1296–1301.CrossRefGoogle Scholar
Stiel, S, Krumm, N, Pestinger, M, et al. (2012). Antibiotics in palliative medicine-results from a prospective epidemiological investigation from the HOPE survey. Support Care Cancer 2012;20:325–333.10.1007/s00520-011-1084-1CrossRefGoogle ScholarPubMed
Furuno, JP, Noble, BN, Horne, KN, et al. Frequency of outpatient antibiotic prescription on discharge to hospice care. Antimicrob Agents Chemother 2014;58:5473–5477.CrossRefGoogle ScholarPubMed
Rosenberg, JH, Albrecht, JS, Fromme, EK, et al. Antimicrobial use for symptom management in patients receiving hospice and palliative care: a systematic review. J Palliat Med 2013;16:1568–1574.CrossRefGoogle ScholarPubMed
Maragakis, LL, Perencevich, EN, Cosgrove, SE. Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther 2008;6:751–763.CrossRefGoogle ScholarPubMed
Levin, PD, Simor, AE, Moses, AE, Sprung, CL. End-of-life treatment and bacterial antibiotic resistance: a potential association. Chest 2010;138:588–594.10.1378/chest.09-2757CrossRefGoogle ScholarPubMed
Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51–e77.CrossRefGoogle Scholar
Gaw, CE, Hamilton, KW, Gerber, JS, Szymczak, JE. Physician perceptions regarding antimicrobial use in end-of-life care. Infect Control Hosp Epidemiol 2018;39:383–390.10.1017/ice.2018.6CrossRefGoogle ScholarPubMed
Bjorkman, I, Berg, J, Roing, M, Erntell, M, Lundborg, CS. Perceptions among Swedish hospital physicians on prescribing of antibiotics and antibiotic resistance. Qual Saf Health Care 2010;19(6):e8.Google ScholarPubMed
Teixeira Rodrigues, A, Roque, F, Falcão, A, Figueiras, A, Herdeiro, MT. Understanding physician antibiotic prescribing behaviour: a systematic review of qualitative studies. Int J Antimicrob Agent 2013;41:203–212.10.1016/j.ijantimicag.2012.09.003CrossRefGoogle ScholarPubMed
Lim, CJ, Kwong, MW, Stuart, RL, et al. Antibiotic prescribing practice in residential aged care facilities--health care providers’ perspectives. Med J Aust 2014;201:98–102.Google ScholarPubMed
Hinkka, H, Kosunen, E, Lammi, EK, Metsänoja, R, Puustelli, A, Kellokumpu-Lehtinen, P. Decision making in terminal care: a survey of Finnish doctors’ treatment decisions in end-of-life scenarios involving a terminal cancer and a terminal dementia patient. Palliat Med 2002;16:195–204.CrossRefGoogle Scholar
Lacey, D. Tube feeding, antibiotics, and hospitalization of nursing home residents with end-stage dementia: perceptions of key medical decision-makers. Am J Alzheimers Dis Other Demen 2005;20:211–219.CrossRefGoogle ScholarPubMed
Parsons, C, McCorry, N, Murphy, K, et al. Assessment of factors that influence physician decision making regarding medication use in patients with dementia at the end of life. Int J Geriatr Psychiatry 2014;29:281–290.CrossRefGoogle ScholarPubMed
Maslach, C, Schaufeli, WB, Leiter, MP. (2001). Job burnout. Annu Rev Psychol 2001;52:397–422.10.1146/annurev.psych.52.1.397CrossRefGoogle ScholarPubMed
Guidelines for The Terminally Ill Patient Law implementation. Israeli Ministry of Health website. http://www.health.gov.il/hozer/mk07_2008.pdf. Published 2008. Accessed March 17, 2008.Google Scholar
Thomas, K. et al. Prognostic Indicator Guidance (PIG), 4th edition, 2011. The Gold Standards Framework Centre In End of Life Care website. http://www.goldstandardsframework.org.uk/cd-content/uploads/files/. Published October 2011. Accessed 2011. Updated June 2015. Accessed July 3, 2019.Google Scholar
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) website. http://icd9cm.chrisendres.com/index.php?action=contents. Published October 2008. Updated 2009. Accessed July 3, 2019.Google Scholar
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. Charlson comorbidity index. J Chron Dis 1987;40:373–383.CrossRefGoogle Scholar
Polk, RE, Fox, C, Mahoney, A, Letcavage, J, MacDougall, C. Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infect Dis 2007;144:664–670.10.1086/511640CrossRefGoogle Scholar
Yadav, KN, Gabler, NB, Cooney, E, et al. Approximately one in three US adults completes any type of advance directive for end-of-life care. Health Aff (Millwood) 2017;36:1244–1251.10.1377/hlthaff.2017.0175CrossRefGoogle ScholarPubMed
Oulton, J, Rhodes, SM, Howe, C, Fain, MJ, Mohler, MJ. Advance directives for older adults in the emergency department: a systematic review. J Palliat Med 2015;18:500–505.10.1089/jpm.2014.0368CrossRefGoogle ScholarPubMed
Quality assessment—preparation of medical institutions for providing end of life care, 2015. Israeli Ministry of Health website. http://www.health.gov.il/PublicationsFiles/Quality_National_Prog_End_Life.pdf. Published April 2016. Accessed August 2016.Google Scholar
Brezis, M, Lahat, Y, Frankel, M, et al. What can we learn from simulation-based training to improve skills for end-of-life care? Insights from a national project in Israel. Isr J Health Policy Res 2017;6. doi: 10.1186/s13584-017-0169-9.CrossRefGoogle Scholar
Pulcini, C, Williams, F, Molinari, N, Davey, P, Nathwani, D. Junior doctors’ knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland. Clin Microbiol Infect 2011;17:80–87.CrossRefGoogle ScholarPubMed
Yoon, JD, Hunt, NB, Ravella, KC, Jun, CS, Curlin, FA. Physician burnout and the calling to care for the dying: a national survey. Am J Hosp Palliat Care 2017;34:931–937.CrossRefGoogle ScholarPubMed
Deckard, GJ, Hicks, LL, Hamory, BH. The occurrence and distribution of burnout among infectious diseases physicians. J Infect Dis 1992;165:224–228.CrossRefGoogle ScholarPubMed
Grisham, S. Infectious disease physician lifestyle report 2018: personal happiness vs work burnout. Medscape website. https://www.medscape.com/slideshow/2018-lifestyle-infectious-disease-6009227#3. Published January 24, 2018. Accessed July 3, 2019.Google Scholar
Salyers, MP, Bonfils, KA. The relationship between professional burnout and quality and safety in healthcare: a meta-analysis. J Gen Intern Med 2017;32:475–482.CrossRefGoogle ScholarPubMed
Baghban, A, Juthani-Mehta, M. Antimicrobial use at the end of life. Infect Dis Clin N Am 2017;31:639–647.CrossRefGoogle ScholarPubMed
Supplementary material: File

Fedorowsky et al. supplementary material

Appendix

Download Fedorowsky et al. supplementary material(File)
File 12.9 KB