TY - JOUR
T1 - Use of Antibiotics Within the Last 14 Days of Life in Korean Patients
T2 - A Nationwide Study
AU - Wi, Yu Mi
AU - Kwon, Ki Tae
AU - Hwang, Soyoon
AU - Bae, Sohyun
AU - Kim, Yoonjung
AU - Chang, Hyun Ha
AU - Kim, Shin Woo
AU - Cheong, Hae Suk
AU - Lee, Shinwon
AU - Jung, Dong Sik
AU - Sohn, Kyung Mok
AU - Moon, Chisook
AU - Heo, Sang Taek
AU - Kim, Bongyoung
AU - Lee, Mi Suk
AU - Hur, Jian
AU - Kim, Jieun
AU - Yoon, Young Kyung
N1 - Publisher Copyright:
© 2023 The Korean Academy of Medical Sciences
PY - 2023
Y1 - 2023
N2 - Background: Antimicrobial prescriptions for serious chronic or acute illness nearing its end stages raise concerns about the potential for futile use, adverse events, increased multidrug-resistant organisms, and significant patient and social cost burdens. This study investigated the nationwide situation of how antibiotics are prescribed to patients during the last 14 days of life to guide future actions. Methods: This nationwide multicenter retrospective cohort study was conducted at 13 hospitals in South Korea from November 1 to December 31, 2018. All decedents were included in the study. Antibiotic use during the last two weeks of their lives was investigated. Results: A total of 1,201 (88.9%) patients received a median of two antimicrobial agents during the last two weeks of their lives. Carbapenems were prescribed to approximately half of the patients (44.4%) in the highest amount (301.2 days of therapy per 1,000 patient-days). Among the patients receiving antimicrobial agents, 63.6% were inappropriate and only 327 patients (27.2%) were referred by infectious disease specialists. The use of carbapenem (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.13–2.03; P = 0.006), underlying cancer (OR, 1.56; 95% CI, 1.20–2.01, P = 0.047), underlying cerebrovascular disease (OR, 1.88; 95% CI, 1.23–2.89, P = 0.004), and no microbiological testing (OR, 1.79; 95% CI, 1.15–2.73; P = 0.010) were independent predictors for inappropriate antibiotic prescribing. Conclusion: A considerable number of antimicrobial agents are administered to patients with chronic or acute illnesses nearing their end-of-life, a high proportion of which are prescribed inappropriately. Consultation with an infectious disease specialist, in addition to an antimicrobial stewardship program, may be necessary to induce the optimal use of antibiotics.
AB - Background: Antimicrobial prescriptions for serious chronic or acute illness nearing its end stages raise concerns about the potential for futile use, adverse events, increased multidrug-resistant organisms, and significant patient and social cost burdens. This study investigated the nationwide situation of how antibiotics are prescribed to patients during the last 14 days of life to guide future actions. Methods: This nationwide multicenter retrospective cohort study was conducted at 13 hospitals in South Korea from November 1 to December 31, 2018. All decedents were included in the study. Antibiotic use during the last two weeks of their lives was investigated. Results: A total of 1,201 (88.9%) patients received a median of two antimicrobial agents during the last two weeks of their lives. Carbapenems were prescribed to approximately half of the patients (44.4%) in the highest amount (301.2 days of therapy per 1,000 patient-days). Among the patients receiving antimicrobial agents, 63.6% were inappropriate and only 327 patients (27.2%) were referred by infectious disease specialists. The use of carbapenem (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.13–2.03; P = 0.006), underlying cancer (OR, 1.56; 95% CI, 1.20–2.01, P = 0.047), underlying cerebrovascular disease (OR, 1.88; 95% CI, 1.23–2.89, P = 0.004), and no microbiological testing (OR, 1.79; 95% CI, 1.15–2.73; P = 0.010) were independent predictors for inappropriate antibiotic prescribing. Conclusion: A considerable number of antimicrobial agents are administered to patients with chronic or acute illnesses nearing their end-of-life, a high proportion of which are prescribed inappropriately. Consultation with an infectious disease specialist, in addition to an antimicrobial stewardship program, may be necessary to induce the optimal use of antibiotics.
KW - Antimicrobial Agents
KW - Antimicrobial Stewardship Programs
KW - Carbapenem
KW - Inappropriate
KW - Terminally Ill
UR - http://www.scopus.com/inward/record.url?scp=85149999186&partnerID=8YFLogxK
U2 - 10.3346/JKMS.2023.38.E66
DO - 10.3346/JKMS.2023.38.E66
M3 - Article
C2 - 36880107
AN - SCOPUS:85149999186
SN - 1011-8934
VL - 38
JO - Journal of Korean Medical Science
JF - Journal of Korean Medical Science
IS - 9
M1 - e66
ER -