1077. Antimicrobial Use at the End of Life among Hospitalized Patients with Advanced Cancer
Session: Poster Abstract Session: Infection in Immunocompromised Patients
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Patients with advanced cancer often receive broad spectrum antimicrobials when hospitalized near the end of life. Although infections can impact quality of life, treatment with antimicrobials is not always therapeutically neutral.  We sought to evaluate antimicrobial use among patients with advanced cancer in order to identify opportunities for improving quality of care.

Methods:  Retrospective review of adult patients experiencing cancer-related death as inpatients at a tertiary care hospital from 2004-2007.

Results:  Among 145 patients meeting inclusion criteria, 126 (87%) received parenteral antimicrobial therapy during hospitalization prior to death. Among the 126, 34/126 (27%) had fever at the time of admission and 88/126 (70%) had radiographic or other findings suggestive of possible infection.  Documented infection, based on clinical exam and microbiologic cultures was present in 61/126 (48%). The mean duration of antimicrobial therapy was 12.5 ± 12.9 days (median 8, range 1-55). Among patients with leukemia (n=37), mean duration was 19.2 ± 14.5 (median 17, p= < 0.001). On average, antimicrobials were discontinued 1 day prior to death.  A “comfort care” goal was ultimately pursued for 99/126 (78.5%) patients; 35/99 (35.4%) continued to receive antimicrobials after a transition to “comfort care” for an average of 1.6 ± 1.1 days (median 1, range 1-6).

Conclusion:  Antimicrobial therapy was very common among patients hospitalized with advanced cancer.  On average, antimicrobials were continued until 1 day prior to cancer-related death.  Even after transition to “comfort care” status, more than one third of patients remained on antimicrobials.  The relative benefits and burdens of antimicrobial therapy for dying patients should be carefully examined particularly among patients where comfort is the goal.


Subject Category: J. Clinical practice issues

Andrew Thompson, M.D., Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, Maria Silveira, M.D., Internal Medicine, University of Michigan, Ann Arbor, MI and Preeti N. Malani, MD, Veterans Affairs Healthcare System, Ann Arbor, MI

Disclosures:

A. Thompson, None

M. Silveira, None

P. N. Malani, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.