Executive Summary: State-of-the-Art Review: Use of Antimicrobials at the End of Life

作者：Daniel Karlin, Christine Pham, Daisuke Furukawa, Ishminder Kaur, Emily J. Martin, Olivia S. Kates, Tara Vijayan · 发表于：Clinical Infectious Diseases · 年份：2024 · DOI：10.1093/cid/ciad737 · 被引用次数：6 · 研究领域：Palliative Care and End-of-Life Issues、Ethics in medical practice

Navigating the use of antimicrobials at the end of life is a challenge for infectious diseases (ID) physicians who remain deeply committed to providing patient-centered care and engaging in shared decision making while also promoting antimicrobial stewardship. ID physicians, who maintain continuity of care for patients with refractory or recurrent infections in the inpatient and outpatient settings can provide thoughtful, calibrated guidance during a particularly vulnerable moment in patients' lives. Hospitalizations from recurrent infections often result in progressive asthenia and functional decline. Our discussion centers around a patient with unresectable cholangiocarcinoma whose recurrent infections pose various challenges as her clinical condition evolves. We emphasize the importance of setting clear expectations and identifying achievable goals as integral parts of shared decision making. We offer strategies for engaging in these challenging conversations with patients and their families (Table 1) and characterize ethical concerns ID physicians frequently encounter. Using REMAP in Early and Late Goals of Care Conversations Abbreviation: ICU, intensive care unit. Without adequate source control, management of infections in patients with obstructive cancers becomes increasingly difficult owing to drug intolerances, barriers to using oral medications, and the development of increasingly drug-resistant pathogens. Benefits of antimicrobials become less clear in incurable in...