Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
J Korean Med Sci. 2023 Mar 6;38(9):e66. doi: 10.3346/jkms.2023.38.e66.
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.
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.
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; = 0.006), underlying cancer (OR, 1.56; 95% CI, 1.20-2.01, = 0.047), underlying cerebrovascular disease (OR, 1.88; 95% CI, 1.23-2.89, = 0.004), and no microbiological testing (OR, 1.79; 95% CI, 1.15-2.73; = 0.010) were independent predictors for inappropriate antibiotic prescribing.
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.
对于即将进入终末期的严重慢性或急性疾病，开具抗菌药物存在潜在的无效使用、不良事件、增加多重耐药菌和显著的患者和社会负担等问题。本研究旨在调查全国范围内在患者生命的最后 14 天内开具抗生素的情况，以指导未来的行动。
这是一项于 2018 年 11 月 1 日至 12 月 31 日在韩国 13 家医院进行的全国多中心回顾性队列研究。所有死者均纳入本研究。调查了他们生命的最后两周内使用抗生素的情况。
共有 1201 名（88.9%）患者在生命的最后两周内接受了中位数为两种抗菌药物的治疗。约一半（44.4%）的患者接受了碳青霉烯类药物治疗（每 1000 个患者天使用 301.2 天的治疗）。在接受抗菌药物治疗的患者中，63.6%的治疗方案是不恰当的，只有 327 名（27.2%）患者由传染病专家转诊。使用碳青霉烯类药物（比值比[OR]，1.51；95%置信区间[CI]，1.13-2.03； = 0.006）、基础癌症（OR，1.56；95%CI，1.20-2.01， = 0.047）、基础脑血管疾病（OR，1.88；95%CI，1.23-2.89， = 0.004）和未进行微生物学检测（OR，1.79；95%CI，1.15-2.73； = 0.010）是不恰当使用抗生素的独立预测因素。
相当数量的抗菌药物用于接近生命末期的慢性或急性疾病患者，其中很大一部分是不恰当使用的。除了抗菌药物管理计划外，可能还需要咨询传染病专家，以促使抗生素的最佳使用。
