WE’RE DELIGHTED TO PRESENT THIS MONTH’S ‘EDITOR’S CHOICE’ FROM ‘PALLIATIVE MEDICINE’, THE OFFICIAL RESEARCH JOURNAL OF THE EAPC
Each month, Professor Catherine Walshe, Editor-in-Chief of ‘Palliative Medicine’, chooses an article that readers may find particularly interesting or useful and invites the authors to draw out the key points on the EAPC blog. Focusing on research that is novel, a robust review, from a specific country or just slightly left of field, the ‘Editor’s Choice’ post aims to share experience and stimulate ideas. We hope you’ll read the longer article in ‘Palliative Medicine’, or EAPC members can access a free copy from the EAPC website.
Tobias Georg Strapatsas, Viola Simons, Beniam Ghebremedhin, Parviz Ahmad-Nejad and Oliver Schmalz give the background to their longer article selected as Editor’s Choice in the June issue of ‘Palliative Medicine’.
In the clinical practice of end-of-life care, the decision to screen a patient for multidrug resistance remains controversial. Multiple factors are involved in such a decision, including disease progression, therapy goals and the patient’s wishes; bearing in mind that a positive result could lead to isolation and negative effects on the quality of end-of-life care.
As palliative care specialists, our primary responsibility is to our patients. However, we also have a responsibly to those who come into contact with them.
In addition to patient specific factors, the prevalence of drug resistant organisms should determine screening strategies, but there remains a lack of data addressing this issue. Therefore, we conducted a study to gather evidence. This was a prospective trial at the HELIOS University Hospital centre in Wuppertal, Germany.
The study found a prevalence for vancomycin-resistant enterococci of 10.5 per cent, for Ciprofloxacin-resistant-extended spectrum beta-lactamases of 5.8 per cent, for Meticillin-resistant Staphylococcus aureus of 5.2 per cent and for Ciprofloxacine-resistant-Carbapenem-resistant isolates of 0.3 per cent. That was higher than that in published normal hospital cohorts. However, the incidence of MRSA was lower than previously published. In our cohort, carrier state of MDRO (Multi-drug resistant organisms) did not affect length of stay or life expectancy.
In conclusion, the decision whether to screen patients remains difficult. While the high prevalence is an argument for testing, the decision for palliative care clinicians is much more finely balanced.
This post relates to the longer article,‘Prevalence of multidrug-resistant organisms on palliative care patients in a university hospital–bound palliative care unit: A prospective cohort analysis’ by Tobias Georg Strapatsas, Viola Simons, Beniam Ghebremedhin, Parviz Ahmad-Nejad and Oliver Schmalz published in Palliative Medicine 2020, 34 (6); pages: 776-783. Article first published online 18 March 2020. Issue published: 1 June 2020. https://doi.org/10.1177/0269216320911591
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