1832. Concordance in End-of-Life Antimicrobial Prescribing Practices among Medicine Subspecialists
Session: Poster Abstract Session: Antimicrobial Stewardship: Non-hospital Settings
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • IDWeek Poster Provider Survey RD 9.25.2018 FINAL.pdf (297.0 kB)
  • Background: Evaluating end-of-life (EOL) antimicrobial prescribing practices may guide stewardship efforts.

    Methods: We conducted a 27-item survey of attending physicians, physician assistants, and nurse practitioners at Yale New Haven Hospital from 1/2018 to 2/2018 using REDCap.

    Results: Of 275 providers surveyed, 109 (40%) responded.  Regardless of specialty, most consider withholding antimicrobials at EOL (n=73/109, 67%), view IV antimicrobials as escalation of care (n=66/109, 61%), believe decision making should involve patients and providers (n=101/109, 93%), and recognize diarrhea as an adverse effect (n=97/109, 89%; Table 1). However, among the subset who conduct advance care planning (N=82), only 49% (N=40/82) discuss antimicrobials.

    Conclusion: Despite agreement in EOL prescribing practices across specialties, antimicrobials are not routinely addressed during advance care planning.  These data support the integration of antimicrobial use into advance care plans linked to stewardship programs.

    Table 1. End-of-life prescribing practices, N (%)

     

     

    Characteristic

    Specialty

    Years Practicing

    Overall

    N=109

    Hematology Oncology

    N=49

    Infectious Diseases

    N=23

    Pulmonary Critical Care

    N=23

    Geriatrics Primary Care

    N=10

    Palliative Care

    N=4

    < 10

    N=52

    ≥ 10

    N=57

    Advance Care Planning

         Conduct above

    82 (75)

    41 (84)

    15 (65)

    12 (52)

    10 (100)

    4 (100)

    35 (67)

    47 (83)

         Discuss antimicrobials

    40

    21

    8

    5

    5

    1

    16

    24

    Barriers to Addressing Antimicrobials

         Lack of time

    36 (33)

    15 (31)

    10 (44)

    7 (30)

    2 (20)

    2 (50)

    17 (33)

    19 (33)

         Family members

    57 (52)

    28 (57)

    16 (70)

    10 (44)

    2 (20)

    1 (25)

    34 (65)

    23 (40)

         Litigation fear

    25 (23)

    11 (23)

    8 (35)

    6 (26)

    0 (0)

    0 (0)

    15 (29)

    10 (18)

    Decision Making

         Patient provider together

    101 (93)

    43 (88)

    22 (96)

    22 (96)

    10 (100)

    4 (100)

    47 (90)

    54 (95)

    Withholding Antimicrobials  

         Consider above

    73 (67)

    35 (71)

    15 (65)

    10 (46)

    9 (90)

    4 (100)

    33 (64)

    40 (71)

         Deem unethical

    8 (7)

    5 (10)

    1 (4)

    2 (9)

    0 (0)

    0 (0)

    4 (8)

    4 (7)

    Escalation of Care

         IV antimicrobials

    66 (61)

    26 (53)

    15 (65)

    16 (70)

    6 (60)

    3 (75)

    26 (50)

    40 (70)

         Restricted antimicrobials

    66 (61)

    26 (53)

    14 (61)

    17 (74)

    5 (50)

    4 (100)

    28 (54)

    38 (67)

    IV Antimicrobial Adverse Effects

         Line discomfort

    81 (74)

    34 (69)

    19 (83)

    18 (78)

    8 (80)

    2 (50)

    37 (71)

    44 (77)

         Diarrhea

    97 (89)

    43 (88)

    20 (87)

    22 (96)

    9 (90)

    3 (75)

    46 (88)

    51 (89)

     

    Rupak Datta, MD PhD1, Dayna McManus, PharmD, BCPS AQ-ID2, Jeffrey Topal, MD3, Tara Sanft, MD4, Vincent Quagliarello, MD, FIDSA1, Louise Marie Dembry, MD, MS, MBA, FSHEA1, Laura Morrison, MD, FAAHPM5 and Manisha Juthani-Mehta, MD, FIDSA, FSHEA1, (1)Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, (2)Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, (3)Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, (4)Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT, (5)Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT

    Disclosures:

    R. Datta, None

    D. McManus, None

    J. Topal, None

    T. Sanft, None

    V. Quagliarello, None

    L. M. Dembry, None

    L. Morrison, None

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

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.