Application of Stewardship in Palliative Care

The unrestricted use of antimicrobials in terminal diseases may bring deleterious effects to patients, such as questionable and poorly generalizable benefits in terms of symptom control and survival gain, in addition to increased hospital costs and antimicrobial resistance. The present study aims to describe the collaboration of the palliative care team in antimicrobial stewardship in a philanthropic hospital. Patients in terminal care who are using antimicrobials are evaluated regarding survival estimates and whether the antimicrobial in use aims at cure, infection control, or symptom control. Daily, the pharmacist of the stewardship team receives the list of patients followed by the palliative care team and verifies them regarding antimicrobial use. Interventions related to the appropriateness of the prescription or escalation are compiled to generate pharmacoeconomic indicators. Results obtained in the first semester of 2025 after the interventions of the palliative care team in stewardship demonstrated that there was a reduction in carbapenem prescriptions (3. 45%), which contributes to the reduction of antimicrobial resistance in this hospital unit, in addition to an increment of R116, 608. 85 since there was also a reduction in the use of high-cost antimicrobials and an increase in bed turnover, due to the discharge of patients who had been hospitalized only for the demand of antimicrobial use. With the emerging antimicrobial resistance, the role of professionals involved in stewardship becomes essential as a barrier against the inappropriate use of antimicrobials. The main challenges faced are related to the attending medical team, since it is essential to understand that antimicrobials are not risk-free treatments and, depending on the patient, they may add suffering without effectively changing the prognosis.