Management of healthcare-associated infections at the end of life – a cross-sectional study

A retrospective chart review was performed on 1458 patients admitted to the free-standing hospice between 1 September 2013 and 31 January 2016. A total of 134 (9.2%) patients (123 with advanced cancer) were clinically diagnosed with 172 cases of various healthcare-associated infections (HAI): two, three, and four times in 26, 5, and 1 person/s, respectively. The median length of care within the infected group was 32.0 days (vs. 9.6 days for non-infected). The most prominent infection risk factors identified were prolonged steroid therapy (37.0% of episodes), antibiotics used before the admission (23.7%), and bladder catheterisation (23.9%). The most common types of HAI were lower respiratory tract infection (LRTI; 43.0%), end-of-life infection of unknown origin (EOL-IUO), urinary tract infection (UTI) (17.4% each), and Clostridium difficile-associated diarrhoea (9.9%). Antibiotics most often used were gentamicin (once-only dosage) in EOL-PUO (27.9% of episodes), ceftriaxone in LRTI (17.4%), and levofloxacin in UTI (15.7%). In 18.0% of cases a sequence of two antibiotics was required. In 4.0% of episodes a sole symptomatic therapy was continued. Clinically meaningful improvement after the full course of antimicrobials was achieved in 79.5% of cases. Once-only antimicrobial was still efficacious but less so (52.1%, p = 0.0006) and comparable with sole symptomatic treatment (p = 0.7). The cost of antibiotics was 16.7% of all drug expenses. Antibiotic therapy appeared to be a frequently chosen, effective although expensive symptomatic management at the end of life.