Infect Chemother.  2019 Jun;51(2):89-97. 10.3947/ic.2019.51.2.89.

Implementation of Antimicrobial Stewardship Programs in End-of-Life Care

• Kwon KT

• KMID: 2450865
• DOI: http://doi.org/10.3947/ic.2019.51.2.89

Abstract

Many terminal patients at the end-of-life have been receiving antimicrobial therapy despite concerns including futile use, potential lack of efficacy, increased patient burden, excess costs, high risk of adverse effects, and increased antimicrobial resistance. Thus, the implementation of antimicrobial stewardship programs (ASPs) in end-of-life care needs to be discussed. But, the topics of antimicrobial therapy and ASPs have not been addressed in the Life-Sustaining Treatment Decision Act enacted in the Korea in February 2016. Antimicrobial therapy should be included in the decision-making framework for end-of-life care similar to other life-sustaining treatment decisions. If the antimicrobial therapy is legally considered as a life-sustaining treatment which can be withdrawn or withheld in patients at the end-of-life, the feasibility of implementing ASPs among this patient population may improve. Various researches on antimicrobial therapy for patients at the end-of-life need to be conducted and collaborations are required between ASPs professionals and many other concerned parties involved in the legislative process of the Life-Sustaining Treatment Decision Act. This review aims to summarize previous studies on the use of antimicrobials for end-of-life care and reveal important aspects for applying ASPs to this population in Korea.

Keyword

Antimicrobial stewardship; Palliative care; Withholding treatment

MeSH Terms

Cooperative Behavior
Humans
Korea
Palliative Care
Viperidae
Withholding Treatment

Reference

1. National Agency for Management of Life-Sustaining Treatment. Hospice/palliative care and dying patient's decisions on life-sustaining treatment act (life-sustaining treatment decision act). Accessed 25 May 2019. Available at: https://www.lst.go.kr/decn/contentList.do.

2. Lee SM, Kim SJ, Choi YS, Heo DS, Baik S, Choi BM, Kim D, Moon JY, Park SY, Chang YJ, Hwang IC, Kwon JH, Kim SH, Kim YJ, Park J, Ahn HJ, Lee HW, Kwon I, Kim DK, Kim OJ, Yoo SH, Cheong YS, Koh Y. Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment. J Korean Med Assoc. 2018; 61:509–521.

3. Oh DY, Kim JH, Kim DW, Im SA, Kim TY, Heo DS, Bang YJ, Kim NK. Antibiotic use during the last days of life in cancer patients. Eur J Cancer Care (Engl). 2006; 15:74–79.

4. Kwak YG, Moon C, Kim ES, Kim BN. Frequent prescription of antibiotics and high burden of antibiotic resistance among deceased patients in general medical wards of acute care hospitals in Korea. PLoS One. 2016; 11:e0146852.

5. Mitchell SL, Shaffer ML, Loeb MB, Givens JL, Habtemariam D, Kiely DK, D'Agata E. Infection management and multidrug-resistant organisms in nursing home residents with advanced dementia. JAMA Intern Med. 2014; 174:1660–1667.

6. Juthani-Mehta M, Malani PN, Mitchell SL. Antimicrobials at the end of life: an opportunity to improve palliative care and infection management. JAMA. 2015; 314:2017–2018.

7. Yao CA, Hsieh MY, Chiu TY, Hu WY, Hung SH, Chen CY, Lee LT. Wishes of patients with terminal cancer and influencing factors toward the use of antibiotics in Taiwan. Am J Hosp Palliat Care. 2015; 32:537–543.

8. Marcus EL, Clarfield AM, Moses AE. Ethical issues relating to the use of antimicrobial therapy in older adults. Clin Infect Dis. 2001; 33:1697–1705.

9. Society for Healthcare Epidemiology of America. Infectious Diseases Society of America. Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol. 2012; 33:322–327.

10. Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK, Trivedi KK. Implementing an antibiotic stewardship program: guidelines by the infectious diseases society of America and the society for healthcare epidemiology of America. Clin Infect Dis. 2016; 62:e51–e77.

11. Kim M. The problems and the improvement plan of the hospice/palliative care and dying patient's decisions on life-sustaining treatment act. Korean J Hosp Palliat Care. 2018; 21:1–8.

12. Koh Y, Heo DS, Yun YH, Moon JL, Park HW, Choung JT, Jung HS, Byun BJ, Lee YS. Charactersitics and issues of guideline to withdrawal of a life-sustaining therapy. J Korean Med Assoc. 2011; 54:747–757.

13. National Agency for Management of Life-Sustaining Treatment. The white paper on the legalization of life-sustaining treatment decisions. Accessed 17 May 2019. Available at: https://www.lst.go.kr/comm/referenceDetail.do?pgNo=1&cate=&searchOption=0&searchText=&bno=1080.

14. National Agency for Management of Life-Sustaining Treatment. Monthly report of life-sustaining treatment decisions. Accessed 25 May 2019. Available at: https://www.lst.go.kr/comm/monthlyStatistics.do.

15. Tagashira Y, Kawahara K, Takamatsu A, Honda H. Antimicrobial prescribing in patients with advanced-stage illness in the antimicrobial stewardship era. Infect Control Hosp Epidemiol. 2018; 39:1023–1029.

16. Dyer J, Vaux L, Broom A, Broom J. Antimicrobial use in patients at the end of life in an Australian hospital. Infect Dis Health. 2019; 24:92–97.

17. Kim HA, Park JY. Changes in life-sustaining treatment in terminally ill cancer patients after signing a do-not-resuscitate order. Korean J Hosp Palliat Care. 2017; 20:93–99.

18. Baghban A, Juthani-Mehta M. Antimicrobial use at the end of life. Infect Dis Clin North Am. 2017; 31:639–647.

19. Datta R, Juthani-Mehta M. Burden and management of multidrug-resistant organisms in palliative care. Palliat Care. 2017; 10:1178224217749233.

20. Nakagawa S, Toya Y, Okamoto Y, Tsuneto S, Goya S, Tanimukai H, Matsuda Y, Ohno Y, Eto H, Tsugane M, Takagi T, Uejima E. Can anti-infective drugs improve the infection-related symptoms of patients with cancer during the terminal stages of their lives? J Palliat Med. 2010; 13:535–540.

21. Thompson AJ, Silveira MJ, Vitale CA, Malani PN. Antimicrobial use at the end of life among hospitalized patients with advanced cancer. Am J Hosp Palliat Care. 2012; 29:599–603.

22. Smits WK, Lyras D, Lacy DB, Wilcox MH, Kuijper EJ. Clostridium difficile infection. Nat Rev Dis Primers. 2016; 2:16020.

23. Levin PD, Simor AE, Moses AE, Sprung CL. End-of-life treatment and bacterial antibiotic resistance: a potential association. Chest. 2010; 138:588–594.

24. Sedef AM, Kose F, Mertsoylu H, Ozyilkan O. Procalcitonin as a biomarker for infection-related mortality in cancer patients. Curr Opin Support Palliat Care. 2015; 9:168–173.

25. Gaw CE, Hamilton KW, Gerber JS, Szymczak JE. Physician perceptions regarding antimicrobial use in end-of-life care. Infect Control Hosp Epidemiol. 2018; 39:383–390.

26. Rosenberg JH, Albrecht JS, Fromme EK, Noble BN, McGregor JC, Comer AC, Furuno JP. Antimicrobial use for symptom management in patients receiving hospice and palliative care: a systematic review. J Palliat Med. 2013; 16:1568–1574.

27. Albrecht JS, McGregor JC, Fromme EK, Bearden DT, Furuno JP. A nationwide analysis of antibiotic use in hospice care in the final week of life. J Pain Symptom Manage. 2013; 46:483–490.

28. Koh SJ, Kim S, Kim J, Keam B, Heo DS, Lee KH, Kim BS, Kim JH, Chang HJ, Baek SK. Experiences and opinions related to end-of-life eiscussion: from oncologists' and resident physicians' perspectives. Cancer Res Treat. 2018; 50:614–623.

29. White PH, Kuhlenschmidt HL, Vancura BG, Navari RM. Antimicrobial use in patients with advanced cancer receiving hospice care. J Pain Symptom Manage. 2003; 25:438–443.

30. Yun YH, Han KH, Park S, Park BW, Cho CH, Kim S, Lee DH, Lee SN, Lee ES, Kang JH, Kim SY, Lee JL, Heo DS, Lee CG, Lim YK, Kim SY, Choi JS, Jeong HS, Chun M. Attitudes of cancer patients, family caregivers, oncologists and members of the general public toward critical interventions at the end of life of terminally ill patients. CMAJ. 2011; 183:E673–E679.

31. Koh SJ, Kim S, Park J, Park KE. Attitudes and opinions of elderly patients and family caregivers on end-of-life care discussion. Ann Geriatr Med Res. 2017; 21:49–55.

32. Broom J, Broom A, Good P, Lwin Z. Why is optimisation of antimicrobial use difficult at the end of life? Intern Med J. 2019; 49:269–271.

33. Abdel-Karim IA, Sammel RB, Prange MA. Causes of death at autopsy in an inpatient hospice program. J Palliat Med. 2007; 10:894–898.