110 199

Cited 4 times in

Use of antimicrobial agents in actively dying inpatients after suspension of life-sustaining treatments: Suggestion for antimicrobial stewardship

Authors
 Dayeong Kim  ;  Subin Kim  ;  Kyoung Hwa Lee  ;  Sang Hoon Han 
Citation
 JOURNAL OF MICROBIOLOGY IMMUNOLOGY AND INFECTION, Vol.55(4) : 651-661, 2022-08 
Journal Title
JOURNAL OF MICROBIOLOGY IMMUNOLOGY AND INFECTION
ISSN
 1684-1182 
Issue Date
2022-08
MeSH
Anti-Bacterial Agents ; Antimicrobial Stewardship* ; Humans ; Inpatients ; Intensive Care Units
Keywords
Actively dying patient ; Advance directives ; Antibiotics ; Antimicrobial stewardship ; Life-sustaining treatment ; Suspension
Abstract
Background: The role of antimicrobial treatment in end-of-life care has been controversial, whether antibiotics have beneficial effects on comfort and prolonged survival or long-term harmful effects on increasing antimicrobial resistance. We assessed the use of antimicrobial agents and factors associated with de-escalation in inpatients who suspended life-sustaining treatments (SLST) and immediately died.

Methods: We included 1296 (74.7%) inpatients who died within 7 days after SLST out of 1734 patients who consented to SLST on their own or family's initiative following a decision by two physicians, observing the "Life-sustaining Treatment Decision Act" between January 2020 and December 2020 at two teaching hospitals. De-escalation was defined as changing to narrower spectrum anti-bacterial drugs or stopping ≥ one antibiotic of combined treatment.

Results: 90.6% of total patients received anti-bacterial agents, particularly a combination treatment in 60.1% and use of ≥ three drugs in 18.2% of them. Antifungal and antiviral drugs were administered to 12.6% and 3.3% of the patients on SLST, respectively. Antibacterial and antifungal agents were withdrawn in only 8.3% and 1.3% of the patients after SLST, respectively. Anti-bacterial de-escalation was performed in 17.0% of patients, but 43.6% of them received more or broad-spectrum antibiotics after SLST. In multivariate regression, longer hospital stays before SLST, initiation of SLST in the intensive care unit, and cardiovascular diseases were independently associated with anti-bacterial de-escalation after SLST.

Conclusions: The intervention for substantial antibiotic use in patients on SLST should be carefully considered as antimicrobial stewardship after decision by the will of the patient and proxy.
Files in This Item:
T202203591.pdf Download
DOI
10.1016/j.jmii.2022.03.003
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dayeong(김다영)
Kim, Subin(김수빈)
Lee, Kyoung Hwa(이경화) ORCID logo https://orcid.org/0000-0003-0033-1398
Han, Sang Hoon(한상훈) ORCID logo https://orcid.org/0000-0002-4278-5198
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/191751
사서에게 알리기
  feedback

qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Browse

Links