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Antibiotics often used for pediatric patients at end of life

At IDWeek 2022, Patrick LLoyd, DO, presented research showing antibiotics are often administered to pediatric patients at end of life, even in cases without infection.

Pediatric patients at the end of life are often given antibiotics, according to a recent study presented at IDWeek 2022 by Patrick LLoyd, DO, Children's Hospital Omaha.

While adult patients are often given antibiotics at the end of life, there is little data about antibiotic use in children at the end of life. Antibiotics can treat and prevent infection in vulnerable populations, but antibiotic use when unneeded can lead to adverse outcomes.

To analyze antibiotic use in children at the end of life, investigators conducted a retrospective review of pediatric patients given palliative care consultation during the last 30 days of life from June 2012 to December 2013.

Data was gathered from tertiary care pediatric hospitals, providing demographic characteristics, hospice status, primary diagnosis, and do not resuscitate (DNR) status. Records on number of days given antibiotics were also collected.

There were 151 patients in the study, 67 of whom were female. The mean age of death was 3.5 years. Chronic progressive illness caused 88% of deaths, chronic status illness 8.7%, and acute illness 3.3%. Oncologic diagnoses were the most common at 37%, followed by cardiac at 21%, genetic metallic at 13%, and neurological at 11%.

DNR status was recorded in 72% of patients and hospice in 7.2%. The most common organism used was antimicrobial at 50%, followed by no documented indication at 22.8%, empiric therapy at 20.5%, and prophylaxis only at 2.7%. Vancomycin was the most common agent used, followed by meropenem, ceftazidime, and cefepime.

Antibiotic use was recorded over 2126 days total. In the last 30 days of life, the median number of unique antibiotics used was 2. Even in cases of no documented infection, antibiotic use was common during the last 30 days of life. Investigators recommended that future conversation between providers and parents involve goals of care and risk of adverse events.

Reference

LLoyd, P. End-of-life use of antibiotics in pediatric patients. Presented at: IDWeek 2022, October 22, 2022, Washington DC.