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Advisor(s)
Abstract(s)
Introdução: A administração de antibióticos é comum nos Cuidados de Fim de Vida,
apesar da sua utilização não ser consensual e da ausência de guidelines. Por isso,
levantam-se questões relativamente ao que será mais apropriado realizar.
Objetivo: Compreender o papel da terapia antibiótica em Cuidados de Fim de Vida.
Metodologia: Foi elaborada uma revisão sistemática integrativa com síntese narrativa
da literatura. A pesquisa foi efetuada com recurso às bases de dados PubMed/MEDLINE e
SciELO e complementada por pesquisa direcionada em revistas científicas. Foram
selecionados estudos que cumprissem os critérios de elegibilidade previamente definidos.
Resultados: Foram incluídos 29 estudos. Verificou-se um predomínio das infeções dos
tratos respiratório inferior e urinário e sepsis. Os microrganismos mais comuns eram
Gram-negativos e houve registos bastante elevados de resistências. Observou-se uma
elevada utilização de antibióticos, muitas vezes, de forma empírica. Fatores como consulta
de Cuidados Paliativos, diretivas antecipadas de vontade, características do médico e do
paciente influenciavam a probabilidade de receber antibióticos. As decisões eram quase
sempre feitas por médicos. A abstenção e/ou a suspensão era(m) efetuada(s) em caso de
complicações ou deterioração clínica. Constatou-se a ocorrência de efeitos adversos,
prolongamento da hospitalização e mortalidade.
Conclusão: A prescrição de antibioterapia, em fim de vida, reflete, muitas vezes, uma
ausência de ponderação e reflexão sobre as necessidades e os desejos dos pacientes e o
impacto comunitário que pode originar. Será necessário um investimento por parte dos
profissionais de saúde para melhorarem as suas competências. Os princípios bioéticos
devem reger a atuação terapêutica aliados sempre a uma tomada de decisão partilhada
consciente, ponderada, refletida e com base ética.
Introduction: In end-of-life care, there are no available guidelines for antibiotic therapy and its usage is not consensual. Nevertheless, antibiotics are still administered. Therefore, it is important to understand if antibiotics are appropriate. Objective: To understand the role of antibiotic therapy in end-of-life care. Methods: An integrative systematic review with narrative synthesis of the literature was conducted. The search was performed using PubMed/MEDLINE and SciELO alongside hand search from scientific journals. Studies were selected according to previously determined eligibility criteria. Results: 29 studies were included. Lower respiratory tract infections, urinary tract infections, and sepsis were the most common infections. The most common microorganisms were Gram-negative. There were high rates of resistant organisms. High usage of antibiotics was identified, mostly empirically. Antimicrobials were associated with higher mortality, more adverse events, and increased length of stay. Palliative Care consultation, advanced directives, and doctor’s and patient’s characteristics influence the likelihood of receiving antibiotics. The decision-making process almost always depends on doctors. Withholding or withdrawing took place if complications or clinical deterioration arose. Conclusion: Antibiotic prescription at the end-of-life reflects a lack of reflection on the needs and wishes of the patient and the potential community impact. Healthcare professionals should strive to improve their skills. Clinical practice should incorporate bioethical principles with a conscious and pondered decision.
Introduction: In end-of-life care, there are no available guidelines for antibiotic therapy and its usage is not consensual. Nevertheless, antibiotics are still administered. Therefore, it is important to understand if antibiotics are appropriate. Objective: To understand the role of antibiotic therapy in end-of-life care. Methods: An integrative systematic review with narrative synthesis of the literature was conducted. The search was performed using PubMed/MEDLINE and SciELO alongside hand search from scientific journals. Studies were selected according to previously determined eligibility criteria. Results: 29 studies were included. Lower respiratory tract infections, urinary tract infections, and sepsis were the most common infections. The most common microorganisms were Gram-negative. There were high rates of resistant organisms. High usage of antibiotics was identified, mostly empirically. Antimicrobials were associated with higher mortality, more adverse events, and increased length of stay. Palliative Care consultation, advanced directives, and doctor’s and patient’s characteristics influence the likelihood of receiving antibiotics. The decision-making process almost always depends on doctors. Withholding or withdrawing took place if complications or clinical deterioration arose. Conclusion: Antibiotic prescription at the end-of-life reflects a lack of reflection on the needs and wishes of the patient and the potential community impact. Healthcare professionals should strive to improve their skills. Clinical practice should incorporate bioethical principles with a conscious and pondered decision.
Description
Keywords
Antibióticos Cuidados Paliativos Ética Fim de Vida Tomada de Decisão