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Antibiotic stewardship program (ASP) in palliative care: antibiotics, to give or not to give

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Abstract

Antimicrobial therapy in terminally ill patients remains controversial as goals of care tend to be focused on optimizing comfort. International guidelines recommend for antibiotic stewardship program (ASP) involvement in antibiotic decisions in palliative patients. The primary objective was to evaluate the clinical impact of ASP interventions made to stop broad-spectrum intravenous antibiotics in terminally ill patients. This was a retrospective chart review of 459 terminally ill patients in Singapore General Hospital audited by ASP between December 2010 and December 2018. Antibiotic duration, time-to-terminal discharge for end-of-life care, time-to-mortality, and mortality rates of patients with antibiotics ceased or continued upon ASP recommendations were compared. A total of 283 and 176 antibiotic courses were ceased and continued post-intervention, respectively. The intervention acceptance rate was 61.7%. The 7-day mortality rate (47.3% vs 61.9%, p = 0.003) was lower in the ceased group, while 30-day mortality rate (76.0% vs 81.2%, p = 0.203) and time-to-mortality post-intervention (3 [0–24] vs 2 [0–27] days, p = 0.066) did not differ between the ceased and continued groups. After excluding the 57 patients who had antibiotics continued until death within 48 h of intervention, only time-to-mortality post-intervention was statistically significantly shorter in the ceased group (3 [0–24] vs 4 [0–27], p < 0.001). Of the 131 terminally discharged patients, antibiotic duration (4 [0–17] vs 6.5 [1–14] days, p = 0.001) and time-to-terminal discharge post-intervention (6 [0–74] vs 10.5 [3–63] days, p = 0.001) were shorter in the ceased group. Antibiotic cessation in terminally ill patients was safe, and was associated with a significantly shorter time-to-terminal discharge.

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Funding

This work was supported in part by the National Medical Research Council, Singapore (NMRC/CG/C005/2017, NMRC/CG/M011/2017).

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Author notes

  1. Kai Chee Hung and Lai Wei Lee share co-authorship.

Authors and Affiliations

  1. Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore

    Kai Chee Hung, Lai Wei Lee, Yi Xin Liew & Andrea Lay-Hoon Kwa

  2. Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore

    Lalit Krishna

  3. Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore

    Maciej Piotr Chlebicki & Shimin Jasmine Chung

  4. Emerging Infectious Diseases, Duke-National University of Singapore Medical School, 8 College Rd, Singapore, 169857, Singapore

    Andrea Lay-Hoon Kwa

  5. Singhealth Duke-NUS Medicine Academic Clinical Programme, 8 College Road, Level 4, Singapore, 169857, Singapore

    Andrea Lay-Hoon Kwa

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  1. Kai Chee Hung
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Contributions

Kai Chee Hung, Lai Wei Lee, Yi Xin Liew: conception and design of study, acquisition of data, analysis and interpretation of data, drafting of article and/or critical revision, and final approval of the manuscript. Lalit Krishna, Maciej Piotr Chlebicki, Shimin Jasmine Chung, and Andrea Lay-Hoon Kwa: analysis and interpretation of data, drafting of article and/or critical revision, and final approval of the manuscript.

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Correspondence to Andrea Lay-Hoon Kwa.

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This study was approved by the SingHealth Centralised Institutional Review Board (CIRB Ref: 2010/114/E).

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Hung, K.C., Lee, L.W., Liew, Y.X. et al. Antibiotic stewardship program (ASP) in palliative care: antibiotics, to give or not to give. Eur J Clin Microbiol Infect Dis 41, 29–36 (2022). https://doi.org/10.1007/s10096-021-04325-z

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  • DOI: https://doi.org/10.1007/s10096-021-04325-z

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