Rosa William E, Pandey Shila, Wisniewski Renee, Blinderman Craig, Cheong Mark Wing Loong, Correa-Morales Juan Esteban, Cubides-Diaz Diego Alejandro, Folorunso Sharif, Gafer Nahla, Marhoom Mohja, Newman Tiffanny, Ntizimira Christian, Obadare Temitope Oyewole, Papan Cihan, Pérez-Cruz Pedro Emilio, Radbruch Lukas, Rajahram Giri Shan, Reyes-Barros Tomás Alejandro, Salins Naveen, Saravu Kavitha, Sullivan Donald R, Dee Edward Christopher
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Lancet Infect Dis. 2025 Jul;25(7):e416-e431. doi: 10.1016/S1473-3099(24)00832-6. Epub 2025 Mar 3.
Global rates of antimicrobial consumption increased by 65% between 2000 and 2015, by 16% between 2016 and 2023, and are estimated to increase by an additional 52% by 2030. Antimicrobial use and misuse remains high among people with serious illness and at end of life, despite scarce evidence of benefit. In addition, the overuse and misuse of antimicrobials at end of life further exacerbate antimicrobial resistance, which is a substantial public and global health concern. This Personal View synthesises global interprofessional and multidisciplinary perspectives on antimicrobial use, stewardship, and resistance at end of life and implications at patient and population levels. Guidelines have been summarised from multiple countries, some of which offer guidance for antimicrobial use at end of life. Countries at different income levels are included (ie, Chile, Colombia, Germany, India, Malaysia, Nigeria, Rwanda, and Sudan) to show how practice norms and standards vary internationally. These examples are combined with a case of non-beneficial end-of-life antimicrobial use and clinical guidance for patient and family communication regarding antimicrobial treatment. This Personal View also provides recommendations to improve antimicrobial stewardship with the goal of engaging multidisciplinary stakeholders and decreasing inappropriate antimicrobial use at end of life.
2000年至2015年间，全球抗菌药物消费量增长了65%，2016年至2023年间增长了16%，预计到2030年还将额外增长52%。尽管几乎没有证据表明有益，但在重症患者和临终患者中，抗菌药物的使用和滥用情况仍然很高。此外，临终时抗菌药物的过度使用和滥用进一步加剧了抗菌药物耐药性，这是一个重大的公共卫生和全球健康问题。这篇个人观点文章综合了全球跨专业和多学科对抗菌药物在临终时的使用、管理及耐药性的观点，以及对患者和人群层面的影响。总结了多个国家的指南，其中一些为临终时抗菌药物的使用提供了指导。纳入了不同收入水平的国家（即智利、哥伦比亚、德国、印度、马来西亚、尼日利亚、卢旺达和苏丹），以展示国际上实践规范和标准的差异。这些例子与一个临终时使用抗菌药物无益处的案例以及关于抗菌治疗的患者和家属沟通的临床指导相结合。这篇个人观点文章还提出了改进抗菌药物管理的建议，目标是让多学科利益相关者参与进来，并减少临终时不适当的抗菌药物使用。
