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Use of antibiotics among end-of-life hospitalized patients with advanced directives: Status examination and association with infectious disease consultation and physician burnout

Published online by Cambridge University Press:  28 August 2019

Rina Fedorowsky Open the ORCID record for Rina Fedorowsky [Opens in a new window] ,
Yaacov G. Bachner ,
Abraham Borer ,
Pnina Ciobotaro  and
Talma Kushnir
Rina Fedorowsky*
Affiliation:
Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheba, Israel Infection Control Unit, Rabin Medical Center, Hasharon Hospital, Petach Tikva, Israel
Yaacov G. Bachner
Affiliation:
Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheba, Israel
Abraham Borer
Affiliation:
Infection Control Unit, Soroka Medical Center, Beer-Sheba, Israel
Pnina Ciobotaro
Affiliation:
Infection Control Unit, Kaplan Medical Center, Rehovot, Israel
Talma Kushnir
Affiliation:
Department of Psychology, Ariel University, Ariel, Israel
*
Author for correspondence: Rina Fedorowsky MA, Rabin Medical Center, Hasharon Hospital, Infection Control Unit, Petakh Tikva 49372, Israel. Email: rinap@clalit.org.il or rinafedo@gmail.com.
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Abstract

Background:

Overuse of antibiotics in end-of-life patients with advanced directives increases bacterial resistance and causes morbidity and mortality. Consultations with infectious disease (ID) physicians and burnout, which can affect antibiotic days of therapy (DOT) prescribed by physicians, have not been examined so far.

Objectives:

To assess antibiotic use by physicians in end-of-life (EOL) patients with advanced directives and to investigate the association between ID consultations, physician burnout, and antibiotic DOT in those patients.

Design:

A descriptive correlational study.

Setting:

Acute-care and post–acute-care hospitals.

Participants:

The study included 213 physicians and 932 their hospitalized patients in the last 2 weeks of life

Methods:

We distributed questionnaires and analyzed the data collected regarding ID consultation, EOL antibiotics prescription with and without an advanced directive, and physician burnout to 278 physicians, and 213 were completed (response rate 76%).

Results:

Of the 932 deaths, 435 of 664 (>50%) were EOL patients with advanced directives. Of these patients, 74% received antibiotics, 29.9% had bacterial resistance cultures, and antibiotics were discontinued in only 5%. Half of the physicians lacked knowledge concerning antibiotics use issues and had significantly fewer consultations with ID physicians in EOL patients with advanced directives (mean rate, 0.27) than those without advanced directives (mean rate, 0.47). ID physicians reported significantly higher emotional exhaustion levels (mean rate, 29) than other medical specialties (mean rate, 19.2). Antibiotic DOT was significantly higher when patients had ID consultations (mean rate, 21.6) than in patients who did not (mean rate, 16.2). In post–acute-care hospitals and/or geriatric wards, antibiotic DOT was significantly higher than in other types of hospitals and/or wards. Depersonalization level was negatively related to antibiotic DOT (P < .05).

Conclusions:

Antibiotics are overused in EOL patients with advanced directives. ID physician burnout and impact of ID consultation should be further assessed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 11 , November 2019 , pp. 1222 - 1228
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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