251. Overuse of Antimicrobials in the End-of-life Care: Factors Influencing Physicians’ Prescribing Behaviors in Treating Patients With an Advanced Stage of Illnesses in the Robust Era of Antimicrobial Stewardship

Abstract

BackgroundAntimicrobials are frequently administered to patients with an advanced stage of illnesses. Understanding current practice of antimicrobial use at the end of life and factors influencing physicians’ prescribing behavior is necessary to provide an effective antimicrobial stewardship program and the best end-of-life care in terminally ill patients.MethodsThe current study was a 1-year retrospective cohort study of patients with an advanced stage of illnesses and was conducted at a 790-bed, public, tertiary care center in Japan. Patterns in current antimicrobial use in the last 14 days of the life of terminally ill patients and the factors influencing physicians’ prescribing behaviors were analyzed.ResultsOf the 260 patients, 192 (73.8%) had an advanced stage malignancy, 136 (52.3%) received antimicrobial therapy in the last 14 days of their life, of whom 60 (44.1%) received antimicrobials for symptom relief. Overall antimicrobial use in the last 14 days of their life was 421.9 days of therapy per 1,000 patient-days. Factors associated with antimicrobial use in this period included a history of antimicrobial use prior to the last 14 days of life during index hospitalization (adjusted odds ratio [aOR]: 4.86; 95% confidence interval [CI]: 2.67–8.84), antipyretic use in the last 14 days of life (aOR: 4.19 95%; CI: 2.01–8.71), and the Charlson comorbidity index ≤ 5 (aOR: 2.18 95%; CI: 1.06–4.53).ConclusionApproximately half of the patients hospitalized with an advanced stage of illnesses received antimicrobials in the last 14 days of their life. Antimicrobials were commonly prescribed and their overall consumption was significant despite their limited efficacy. The factors associated with antimicrobial use at the end-of-life in this study are likely to explain physicians’ prescribing behaviors. In the era of robust antimicrobial stewardship, reconsidering antimicrobial use in terminally ill patients is necessary.Disclosures All authors: No reported disclosures.