TOPLINE

Antibiotic use in patients under hospice care was associated with an increased risk for death. However, patients with infectious hospice-qualifying conditions experienced a survival benefit from antibiotic treatment.

METHODOLOGY

• Researchers retrospectively reviewed patients enrolled in a regional outpatient hospice program between June 2017 and January 2023 to evaluate the association between antibiotic use and survival.
• A total of 6169 patients (median age, 83.2 years) with a hospice-qualifying condition were included; 1233 patients received an antimicrobial prescription during their care.
• Patients were classified into one of nine categories based on their hospice enrollment descriptions: cancer, cardiac, dementia, neurologic, pulmonary, gastrointestinal, infectious, renal, and other.
• The primary outcome was survival time, which was defined as the duration from the date of hospice admission to the date of death.
• Antimicrobial prescribing patterns were analyzed across different hospice-qualifying condition categories. The median time from hospice enrollment to antibiotic prescription was 16 days.

TAKEAWAY

• Antibiotic use was associated with increased risk for death (adjusted hazard ratio [aHR], 1.47; P < .001).
• Patients with cancer hospice-qualifying conditions showed the strongest association with increased mortality following antibiotic use (aHR, 1.67; 95% CI, 1.50-1.87).
• Patients with infectious hospice-qualifying conditions experienced a survival benefit from antibiotic treatment (aHR, 0.60; 95% CI, 0.40-0.89).
• In the 14-day landmark analysis, patients who did not receive antibiotics survived a median of 19 days longer than those who received antibiotics (49 vs 30 days; aHR, 1.38; P < .001). Similarly, in the 28-day landmark analysis, antibiotic-free patients survived a median of 25 days longer than those who received antibiotics (65 vs 40 days; aHR, 1.37; P < .001).

IN PRACTICE

"While patients with infection-related HQCs [hospice qualifying conditions] may benefit, routine antibiotic use appears unlikely to extend life expectancy for most hospice patients. [The study] findings underscore the need for individualized, preference-sensitive prescribing at the end of life," the authors wrote.

SOURCE

The study was led by Patrick D. Crowley, Mayo Clinic Division of Public Health, Infectious Disease and Occupational Medicine in Rochester, Minnesota. It was published online on September 11 in Clinical Infectious Diseases.

LIMITATIONS

Information about why antibiotics were used was lacking. Whether the symptoms were similar for patients who received treatment and those who did not could not be assessed. Data on whether infections were confirmed using tests or if patients had stated any preferences for antibiotics in advance were lacking. The observational study design precluded causal inference.

DISCLOSURES

No specific funding was reported. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.