End-of-Life Infections and the Dilemma of Emerging Antimicrobial Resistance: A Scoping Review.

Abstract

The goals of antimicrobial treatment of end-of-life (EOL) infections are variously defined, raising complex questions about the management futility, ethical aspects, psychosocial burden, and the risk of emerging antimicrobial resistance. The author searched PubMed, Scopus, and Web of Science databases to retrieve relevant articles published from May 1, 2000, to April 30, 2024, on EOL infections and emerging multidrug-resistant organisms. The titles and abstracts of retrieved articles were screened, duplicate records were excluded, and the eligibility of selected papers was assessed. Sixty-one articles were included; the prevalence of EOL infections and antimicrobial therapy were calculated, the common sites and characteristics of EOL infections were identified, and the extent of emerging multidrug-resistant organisms among EOL patients, especially the "superbugs" ones, were estimated. The review indicates that infections are common in terminally ill patients, the prevalence of irrational antimicrobial prescriptions is high globally, with antimicrobials frequently administered until death. Limited data regarding antimicrobial resistance are available, and they cover short periods, while many of those patients survive longer with modern healthcare and become an essential reservoir for emerging multidrug-resistant organisms. This underscores the importance of antimicrobial stewardship programs and the urgent need for further research in this often-overlooked study area.