Antibiotic therapy in patients at the end of life. Analysis of the frequency and reasons for initiating antibiotic therapy in the last week of life in inpatient hospice patients – preliminary report

Introduction
To analyze the frequency and reasons for initiating antibiotic therapy during the last week of life in patients receiving palliative care in an inpatient hospice.

Material and methods
Retrospective analysis of medical records of patients admitted to an inpatient hospice in January 1 – April 30, 2024. Detailed statistical analysis was performed on data from patients who died during their stay.

Results
Of the 173 patients admitted during the study period, 128 (73.9%) died. Antibiotic therapy in the last 7 days of life was administered to 49.2% (95% CI: 40.6–57.9). Among them, 61.9% (95% CI: 49.9–73.9) received one antibiotic, while 6.4% (95% CI: 0.3–12.4) received three or more. The most frequent indication for initiating therapy was new auscultatory changes in the lungs suggesting pneumonia (31.8%). In another 23.8%, the indication was elevated inflammatory markers in blood tests, such as increased C-reactive protein and/or leukocytosis with neutrophilia. The general condition of patients at the time of therapy initiation was assessed as severe in 69.8% of cases.

Conclusions
Approximately half of adult patients receiving palliative care in an inpatient hospice were treated with antibiotics within the last 7 days of life. The most common indications were suspected pneumonia and rising inflammatory markers without a clearly documented source of infection. Making therapeutic decisions regarding whether to initiate or withhold antibiotic therapy in this population is a significant challenge due to the difficulty in distinguishing between a clinical picture suggestive of bacterial infection and symptoms of underlying disease progression. The absence of clear recommendations on antibiotic use in terminally ill patients highlights the need for further studies evaluating the appropriateness of such therapy in the dying population. The results of these studies may support clinical decision-making and help reduce the use of futile treatment.