• Yu Mi Wi, Ki Tae Kwon, Soyoon Hwang, Sohyun Bae, Yoonjung Kim, Hyun-Ha Chang, Shin-Woo Kim, Hae Suk Cheong, Shinwon Lee, Dong Sik Jung, Kyung Mok Sohn, Chisook Moon, Sang Taek Heo, Bongyoung Kim, Mi Suk Lee, Jian Hur, Jieun Kim, Young Kyung Yoon, and Antimicrobial Stewardship Research Committee of Korean Society for Antimicrobial Therapy.
• Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
• J. Korean Med. Sci. 2023 Mar 6; 38 (9): e66e66.

BackgroundAntimicrobial 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.MethodsThis 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.ResultsA 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.ConclusionA 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.© 2023 The Korean Academy of Medical Sciences.

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