Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Infect Control Hosp Epidemiol. 2024 Feb;45(2):201-206. doi: 10.1017/ice.2023.191. Epub 2023 Sep 11.
We evaluated the adequacy of microbiological tests in patients withholding or withdrawing life-sustaining treatment (WLST) at the end stage of life.
The study was conducted at 2 tertiary-care referral hospitals in Daegu, Republic of Korea.
Retrospective cross-sectional study.
Demographic findings, clinical and epidemiological characteristics, statistics of microbiological tests, and microbial species isolated from patients within 2 weeks before death were collected in 2 tertiary-care referral hospitals from January to December 2018. We also reviewed the antimicrobial treatment that was given within 3 days of microbiological testing in patients on WLST.
Of the 1,187 hospitalized patients included, 905 patients (76.2%) had WLST. The number of tests per 1,000 patient days was higher after WLST than before WLST (242.0 vs 202.4). Among the category of microbiological tests, blood cultures were performed most frequently, and their numbers per 1,000 patient days before and after WLST were 95.9 and 99.0, respectively. The positive rates of blood culture before and after WLST were 17.2% and 18.0%, respectively. spp. were the most common microbiological species in sputum (17.4%) and urine (48.2%), and spp. were the most common in blood culture (17.3%). After WLST determination, 70.5% of microbiological tests did not lead to a change in antibiotic use.
Many unnecessary microbiological tests are being performed in patients with WLST within 2 weeks of death. Microbiological testing should be performed carefully and in accordance with the patient's treatment goals.
评估生命终末期患者拒绝或撤回生命维持治疗（WLST）时微生物学检查的充分性。
该研究在韩国大邱的 2 家三级保健转诊医院进行。
回顾性横断面研究。
收集了 2018 年 1 月至 12 月 2 家三级保健转诊医院的人口统计学资料、临床和流行病学特征、微生物学检查统计数据以及死亡前 2 周内从患者身上分离出的微生物种类。我们还回顾了 WLST 患者微生物学检查后 3 天内给予的抗菌治疗。
在纳入的 1187 例住院患者中，905 例（76.2%）接受了 WLST。WLST 后每 1000 个患者日的检查次数高于 WLST 前（242.0 比 202.4）。在微生物学检查类别中，血培养最常进行，其 WLST 前和 WLST 后的每 1000 个患者日的数量分别为 95.9 和 99.0，阳性率分别为 17.2%和 18.0%。 spp.在痰（17.4%）和尿（48.2%）中最常见的微生物种类， spp.在血培养中最常见（17.3%）。在 WLST 确定后，70.5%的微生物学检查没有改变抗生素的使用。
在 WLST 后 2 周内，许多不必要的微生物学检查正在对接受 WLST 的患者进行。微生物学检查应谨慎进行，并根据患者的治疗目标进行。
