Antimicrobial use in patients with end-of-life status in intensive care units: A systematic review and meta-analysis

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Health Services Research

Background:

• Critical care advances have led to increased antimicrobial use in intensive care units (ICUs).
• Antimicrobial prescribing in critically ill patients with end-of-life care status is often continued without clear clinical benefit.
• There is a need to understand current antimicrobial prescribing patterns in this vulnerable patient population.

Purpose of the Study:

• To systematically review and meta-analyze antimicrobial use in critically ill ICU patients with end-of-life care status.
• To estimate the pooled proportion of antimicrobial prescriptions in this patient group.
• To explore regional differences in antimicrobial prescribing.

Main Methods:

• A comprehensive literature search was conducted in Medline (PubMed) and Embase for studies published between January 2000 and August 2023.
• Included studies were interventional and observational, focusing on antimicrobial use in critically ill ICU patients with end-of-life status.
• A meta-analysis was performed to determine the proportion of antimicrobial use, with subgroup analyses by region and national income.

Main Results:

• Twenty-six studies met the inclusion criteria; no randomized or prospective studies were identified.
• The pooled proportion of antimicrobial prescriptions was 0.35 (95% CI, 0.18-0.54), with significant heterogeneity observed.
• Regional differences in antimicrobial use were found: 0.50 in North America, 0.40 in Europe, and 0.24 in the Asia-Pacific region.

Conclusions:

• Studies assessing antimicrobial prescribing in ICU patients with end-of-life care are scarce.
• Approximately one-third of critically ill ICU patients with end-of-life status received antimicrobials.
• Observed regional variations in prescribing patterns may influence overall antimicrobial consumption in ICUs.