J Korean Med Sci.  2023 Mar;38(9):e66. 10.3346/jkms.2023.38.e66.

Use of Antibiotics Within the Last 14 Days of Life in Korean Patients: A Nationwide Study

• Wi YM
• Kwon KT
• Hwang S
• Bae S
• Kim Y
• Chang HH
• Kim SW
• Cheong HS
• Lee S
• Jung DS
• Sohn KM
• Moon C
• Heo ST
• Kim B
• Lee MS
• Hur J
• Kim J
• Yoon YK
• and Antimicrobial Stewardship Research Committee of Korean Society for Antimicrobial Therapy

• KMID: 2540124
• DOI: http://doi.org/10.3346/jkms.2023.38.e66

Abstract

Background
Antimicrobial prescriptions for serious chronic or acute illness nearing its end stages raise concerns about the potential for futile use, adverse events, increased multidrugresistant 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.

Keyword

Terminally Ill; Antimicrobial Agents; Carbapenem; Inappropriate; Antimicrobial Stewardship Programs

Figure

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  Fig. 1 Antimicrobial use in the 14 days before death.

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