Prevalence of antibiotic prescription in the end-of-life care of hospitalised geriatric patients (the APALIM study)

Background : Currently, population aging is a public health issue. End-of-life situations of older patients in hospital are increasingly frequent and raise therapeutic and ethical questions. Patients at the end of their lives, particularly older patients, are more often exposed to infections. The place of antibiotic therapy is central in terminal palliative care. Nevertheless, the use of antibiotics should always be assessed, especially because of the development of bacterial resistance. Therefore, this study assessed the prevalence of antibiotic use in older people at the end of life. Method : This descriptive retrospective study included all patients aged 75 years and older, hospitalised in 2018 at the Limoges University Hospital Centre and at the hospital in Saint-Yrieix la Perche who died in hospital. The primary outcome was the use of an antibiotic in the last 10 days of life. Results : Of the 338 patients included, 237 (70.1%) were treated with an antibiotic and 233 (68.9%) experienced hyperthermia > 38.3°C or hypothermia < 35°C. The most frequent infections were pulmonary (n = 141, 43.3%) and urinary tract (n = 67, 20.1%). Of the patients, 23.3% did not have an established infection diagnosis. Samples were taken from 29% of the patients. Escherichia coli and Staphylococcus aureus were the bacteria most often isolated. Of the patients, 54.4% (n = 129) died while taking antibiotics. For 25.7% (n = 61) of the patients, a doctor decided to stop treatment early. Conclusion : Many older patients at the end of their lives are concerned about antibiotic therapy. In the absence of scientific proof of the effectiveness of antibiotics to relieve patients at the end of life, these treatments should be studied to develop guidelines about their use in terminal palliative care.