• Susan E Merel, Cynthia A Meier, Christy M McKinney, and Paul S Pottinger.
• 1 Division of General Internal Medicine, Department of Medicine, University of Washington , Seattle, Washington.
• J Palliat Med. 2016 Nov 1; 19 (11): 1210-1214.

BackgroundAntimicrobials are commonly used in patients near the end of life, but the percentage and predictors of patients prescribed antibiotics while hospitalized on a comfort care protocol are unknown.ObjectiveTo determine how often patients in the acute care setting are continued on antimicrobials when they are transitioned to comfort-focused care and to describe patient characteristics correlated with antimicrobial use.DesignRetrospective cohort study conducted from June 2012 to August 2014.SettingTwo interrelated academic medical centers.PatientsInpatients >18 years old transitioned to a comfort care protocol.MeasurementsAdministration of antimicrobials to patients on the comfort care protocol.AnalysisWe generated descriptive statistics and used a modified Poisson regression to estimate unadjusted and adjusted associations along with 95% confidence intervals (CIs) and p-values.ResultsThere were 1881 patients included in the study; 77% of patients ultimately transitioned to a comfort care protocol received antimicrobials during their admission and 82% died in hospital. Of the 711 alive at ≥24 hours after comfort care orders, 111 (15.6%) were still on antimicrobials. After adjusting for age, a documented infection was positively associated with being on antibiotics (adjusted relative risk [ARR] = 1.46, 95% CI: 1.00-2.12, p = 0.05). Patients in the medical and surgical intensive care units (ICUs) were less likely than those on medicine to receive antimicrobials (MICU ARR = 0.32, 95% CI: 0.14-0.72, p = 0.01; SICU/Neuro ARR = 0.32, 95% CI: 0.12-0.85, p = 0.02).ConclusionsAntimicrobial use is relatively high in hospitalized patients near the end of life, even when the goal is comfort.

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