254. Antimicrobial Use in Hospitalized Older Patients with Advanced Cancer
Session: Poster Abstract Session: Antimicrobial Stewardship: Special Populations
Thursday, October 4, 2018
Room: S Poster Hall
  • IDWeek Abx LOS RD 9.25.2018 FINAL.pdf (287.3 kB)
  • Background: Antimicrobial use may prolong hospitalization and suffering in patients with advanced cancer whose goals of care transition to comfort measures only (CMO).

    Methods: We conducted a retrospective study of all patients aged ≥ 65 years with stage III-IV solid tumors, stage III-IV lymphomas, or acute, refractory or active liquid tumors requiring chemotherapy or targeted therapies who were transitioned to CMO during hospitalization at Yale New Haven Hospital between 7/2014 and 11/2016. We performed chart review, determined antimicrobial use (including antibiotics, antifungal and antiviral agents) around CMO, and evaluated the association between antibiotic density (use of oral and IV antibiotics by calendar days) and length of stay (LOS) using multivariable linear regression.

    Results: We identified 461 patients. Median age was 74 years (range 65-99), 49% (n=226) were female, and 79.4% (n=366) had solid tumors. Overall, 113 patients (group 1) did not receive antimicrobials within 1 calendar day of CMO transition. Of the 343 patients who did, antimicrobials were continued after CMO in 20% (n=70, group 2) and discontinued in 80% (n=273, group 3). Patients who had antimicrobials continued after transition to CMO spent 1 more day inpatient until discharge compared to those who did not (group 2 vs. 3 in Figure 1). Five patients (group 4) started antimicrobials after CMO transition. In the multivariable model, antibiotic density remained associated with LOS (β = 1.2, 95% CI 1.1, 1.3; P<0.0001) (Table 1).

    Conclusion: During their terminal hospitalization, most older adults with advanced cancer received antimicrobials, and increased antibiotic density was associated with prolonged LOS. Antimicrobial stewardship efforts should be focused on this population to optimize utilization and facilitate transitions of care.


    Figure 1

    Table 1. Predictors of length of stay.


    Estimate (95% CI)

    P value


    -0.07 (-0.16, 0.02)


    Male Gender

    0.15 (-1.14, 1.43)


    Cancer Type




    0.25 (-1.66, 2.17)



    0.28 (-1.64, 2.20)


         Solid tumor, other

    2.24 (0.47, 4.00)


         Liquid tumor



    Rothman Index a

    0.06 (0.03, 0.09)


    Antibiotic Density b

    1.17 (1.10, 1.25)


    a. Marker for clinical severity

    b. Use of oral and IV antibiotics by calendar days


    Mojun Zhu, MD1, Rupak Datta, MD PhD2, Vincent Quagliarello, MD, FIDSA2 and Manisha Juthani-Mehta, MD, FIDSA, FSHEA2, (1)Department of Internal Medicine, Yale School of Medicine, New Haven, CT, (2)Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT


    M. Zhu, None

    R. Datta, None

    V. Quagliarello, None

    M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor , Consulting fee .

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