南部某醫學中心安寧療護的抗生素使用分析

Antibiotic Use in Hospice Care: An Analysis at a Medical Center in Southern Taiwan

抗生素對於感染症的治療非常重要，然而對於安寧療護的末期病人來說，治療目標和一般病人可能有所不同，發生感染症時，是否使用抗生素需要考量更多的因素。目前安寧療護的抗生素使用雖然有許多建議，但尚無一定的準則。本研究目的在於瞭解安寧療護病人使用抗生素的狀況，因此我們收集安寧病房和其他科別於住院期間死亡或病危臨終出院的病人，分析使用抗生素的狀況是否有所不同。我們收錄了2022年10月1日到2023年3月31日共164位死亡病人，包括感染科67人及安寧病房97人，分析顯示同樣是病況差的末期病人，當病人在安寧病房(p<0.01)或是休克(p=0.03)時，較易中止抗生素使用；而當病人使用高濃度氧氣(p=0.01)時則較易繼續施打抗生素。根據結果，安寧病人在評估利弊後確實較傾向停用抗生素，其他科別的臨床醫師在面對末期病人時，或許可以利用醫病共享決策輔助工具或是相關臨床建議，和病人及家屬進行討論，提早中止不需要的抗生素治療。

Antibiotics are important for the treatment of infectious diseases. However, the treatment goal of hospice care may differ from that of a cure. The use of antibiotics needs to be considered for patients in hospice care. Despite existing recommendations, guidelines are still lacking. This study aimed to understand the differences in antibiotic use between hospices and other specialties in cases of end-stage mortality. We enrolled 164 patients, 67 in the infectious disease specialty ward and 97 in the hospice ward. The results showed that physicians tended to cease antibiotic use in hospice wards or when patients presented with shock. In contrast, antibiotics were more likely to be maintained in patients with high oxygen demand. According to these results, physicians were more inclined to discontinue antibiotics in patients in hospice care after evaluating their benefits and disadvantages. To discontinue unnecessary antibiotic therapy early, clinicians from other disciplines may use shared decision-making tools or relevant existing recommendations to discuss with patients and their families when facing terminal conditions.