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Antibiotic prescription for fever episodes in hospice patients
Liang-Kung Chen1, Yu-Ching Chou, Pi-Shan Hsu
1Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec 2, Taiwan 11217.
Abstract:
Bacterial infection usually plays an important part in the fever episodes that are common in patients in the hospice palliative care unit. The physicians' attitude to use of antibiotics in such cases is usually complex. We retrospectively studied 535 admissions to a hospice and palliative care unit in a medical center in Taiwan. Ninety-three fever episodes (16.7%) were identified among these admissions, and 79 fever episodes (84.9%) were treated with antibiotics. The Karnofsky performance status (KPS), verbal communication ability (VCA) and Glasgow Coma Scale (GCS) were all significantly compromised in these febrile patients. Although KPS, VCA and GCS were similar among all patients at the date of admission, these parameters became significantly worse in fever episodes that were left untreated than in those treated with antibiotics. Patients without antibiotic treatment showed a shorter mean survival (8.7 +/- 9.9 days vs 14.6 +/- 13.1 days; P = 0.03) and a higher 3-day mortality rate than those patients with antibiotic treatment (50% vs 15.2%; P = 0.015). In conclusion, appropriate antibiotic use may cause fever to subside and thus decrease the fever-related discomfort. Physicians may tend to withhold antibiotic treatment because of the poorer KPS, VCA, and GCS and poorer estimated prognosis of patients at the time of fever.
Insights
Antibiotic treatment for fever in hospice palliative care patients may improve outcomes. While physicians hesitate due to patient condition, antibiotics can reduce discomfort and potentially improve survival rates.
Area of Science:
- Palliative Care
- Infectious Diseases
- Medical Ethics
Background:
- Fever is common in hospice palliative care, often linked to bacterial infections.
- Physician attitudes towards antibiotic use in this setting are complex.
- Patient performance status (Karnofsky performance status, verbal communication ability, Glasgow Coma Scale) is often compromised.
Purpose of the Study:
- To investigate the impact of antibiotic treatment on fever episodes in hospice palliative care.
- To analyze the relationship between antibiotic use and patient outcomes, including survival and mortality.
- To understand physician decision-making regarding antibiotic prescription in this patient population.
Main Methods:
- Retrospective study of 535 admissions to a hospice palliative care unit in Taiwan.
- Identification and analysis of 93 fever episodes.
- Comparison of outcomes between patients treated with antibiotics and those not treated.
Main Results:
- 84.9% of fever episodes were treated with antibiotics.
- Patients receiving antibiotics showed significantly better Karnofsky performance status, verbal communication ability, and Glasgow Coma Scale scores compared to untreated patients.
- Antibiotic treatment was associated with longer mean survival (14.6 vs. 8.7 days) and lower 3-day mortality (15.2% vs. 50%).
Conclusions:
- Appropriate antibiotic use can effectively manage fever and reduce patient discomfort in hospice palliative care.
- Physicians may withhold antibiotics due to perceived poor prognosis, but evidence suggests potential benefits.
- Further research into optimal antibiotic stewardship in palliative care is warranted.