- Context: Antibiotic prescribing in hospice patients is complicated by the focus on palliative rather than curative care and concerns regarding increasing antibiotic resistance.
Objective: To estimate antibiotic use in a national sample of hospice patients and identify facility and patient characteristics associated with antibiotic use in this population.
Methods: This was an analysis of data from the 2007 National Home and Hospice Care Survey, a nationally-representative sample of U.S. hospice agencies. We included data from 3,884 patients who died in hospice care. Our primary outcome measure was prevalence of antibiotic use in the last 7 days of life. Diagnoses, including potential infectious indications for antibiotic use, were defined using International Classification of Diseases, Ninth Revision (ICD-9) codes. Chi-square tests and t-tests were used to quantify associations of patient and facility characteristics with antibiotic use.
Results: During the last 7 days of life, 27% (95% confidence interval (CI); 24%, 30%) of patients received at least one antibiotic and 1.3% (95% CI; 0.7%, 2.0%) received ≥ 3 antibiotics. Among patients who received at least one antibiotic, 15% (95% CI; 10%, 20%) had a documented infectious diagnosis, compared with 9% (95% CI; 7%, 11%) who had an infectious diagnosis but received no antibiotics.
Conclusions: In this nationally-representative sample, 27% of hospice patients received an antibiotic during the last 7 days of life, most without a documented infectious diagnosis. Further research is needed to elucidate the role of antibiotics in this patient population to maintain palliative care goals while reducing unnecessary antibiotic use.