Considering inpatient antibiotic use at the end of life for children with cancer

Resumen

In adult oncology, high-quality end-of-life care (EOLC) metrics emphasize minimizing aggressive interventions. Although no guidelines specifically address antibiotic use at end-of-life (EOL), the Infectious Diseases Society of America classifies antibiotics as “aggressive therapy”. Nevertheless, 87% of hospitalized adults with cancer at EOL receive antibiotics in the final week of life, though fewer than half have documented infections. Comparable pediatric metrics are lacking; however, anticipatory guidance is critical for high-quality care. Objective. To describe antibiotic use in children with cancer at end-of-life (EOL) and evaluate documentation of discussions regarding antimicrobial management. Method. Retrospective chart review of children with malignancy who died inpatient at a U.S. academic center (2012–2022). Data included antimicrobial use, microbiological testing, documentation of discussions by Palliative Care (PC) or Infectious Disease (ID), and patient demographics and EOLC variables. IRB reviewed and found it exempt. Results. Of the 303 children, 223 (74%) received antibiotics at the time of death, most given without evidence of infection (65.9%). Only 79 patients (26%) had documented PC or ID discussions about antibiotic management, primarily focused on discontinuation or de-escalation. Conclusions. Antibiotics at pediatric EOL are frequently prescribed without clear evidence of infection and are seldom included in goals-of-care discussions. Standardized processes and anticipatory guidance may reduce reflexive prescribing, promote stewardship, and better align care with family priorities, highlighting the need for protocols that ensure goal–concordant care.