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首页> 外文期刊>Journal of pain and symptom management. >A nationwide analysis of antibiotic use in hospice care in the final week of life
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A nationwide analysis of antibiotic use in hospice care in the final week of life

机译：在生命的最后一周进行的全国临终关怀抗生素使用情况分析

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Context: Antibiotic prescription in hospice patients is complicated by the focus on palliative rather than curative care and concerns regarding increasing antibiotic resistance. Objectives: To estimate the antibiotic use in a national sample of hospice patients and identify facility and patient characteristics associated with antibiotic use in this population. Methods: This was an analysis of data from the 2007 National Home and Hospice Care Survey, a nationally representative sample of U.S. hospice agencies. We included data from 3884 patients who died in hospice care. The primary outcome measure was prevalence of antibiotic use in the last seven days of life. Diagnoses, including potential infectious indications for antibiotic use, were defined using International Classification of Diseases, Ninth Revision (ICD-9) codes. Chi-squared tests and t-tests were used to quantify associations of patient and facility characteristics with antibiotic use. Results: During the last seven days of life, 27% (95% CI: 24%-30%) of patients received at least one antibiotic and 1.3% (95% CI: 0.7%-2.0%) received three or more antibiotics. Among patients who received at least one antibiotic, 15% (95% CI: 10%-20%) had a documented infectious diagnosis compared with 9% (95% CI: 7%-11%), who had an infectious diagnosis but received no antibiotics. Conclusion: In this nationally representative sample, 27% of hospice patients received an antibiotic during the last seven days of life, most without a documented infectious diagnosis. Further research is needed to elucidate the role of antibiotics in this patient population to maintain palliative care goals while reducing unnecessary antibiotic use.
机译：背景：临终关怀患者的抗生素处方因关注姑息治疗而非治疗而变得复杂，并且担心增加抗生素耐药性。目的：评估全国临终关怀患者样本中的抗生素使用情况，并确定与该人群中抗生素使用相关的设施和患者特征。方法：这是对2007年全国家庭和临终关怀调查的数据的分析，这是美国临终关怀机构的全国代表样本。我们纳入了3884名因临终关怀而死亡的患者的数据。主要结局指标是生命最后7天使用抗生素的患病率。使用国际疾病分类第九修订版（ICD-9）编码定义了诊断，包括潜在的抗生素使用感染指征。卡方检验和t检验用于量化患者和设施特征与抗生素使用之间的关联。结果：在生命的最后7天中，有27％（95％CI：24％-30％）的患者至少接受了一种抗生素，而1.3％（95％CI：0.7％-2.0％）的患者接受了三种或更多种抗生素。在接受了至少一种抗生素治疗的患者中，有15％（95％CI：10％-20％）的确诊为传染病，而有9％（95％CI：7％-11％）的确诊为传染病。没有抗生素。结论：在这个全国代表性的样本中，有27％的临终关怀患者在生命的最后7天接受了抗生素治疗，其中大多数没有记录的传染性诊断。需要进一步研究阐明抗生素在该患者人群中的作用，以维持姑息治疗目标，同时减少不必要的抗生素使用。

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