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Use of antimicrobial agents in actively dying inpatients after suspension of life-sustaining treatments: Suggestion for antimicrobial stewardship
DC Field | Value | Language |
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dc.contributor.author | 한상훈 | - |
dc.contributor.author | 이경화 | - |
dc.contributor.author | 김다영 | - |
dc.contributor.author | 김수빈 | - |
dc.date.accessioned | 2022-12-22T02:57:48Z | - |
dc.date.available | 2022-12-22T02:57:48Z | - |
dc.date.issued | 2022-08 | - |
dc.identifier.issn | 1684-1182 | - |
dc.identifier.uri | https://ir.ymlib.yonsei.ac.kr/handle/22282913/191751 | - |
dc.description.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 Antibacterial and antifungal agents were withdrawn in only 8.3% and 1.3% of the patients after SLST, respectively.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. | - |
dc.description.statementOfResponsibility | open | - |
dc.format | application/pdf | - |
dc.language | English, Chinese | - |
dc.publisher | Elsevier for the Taiwan Society of Microbiology | - |
dc.relation.isPartOf | JOURNAL OF MICROBIOLOGY IMMUNOLOGY AND INFECTION | - |
dc.rights | CC BY-NC-ND 2.0 KR | - |
dc.subject.MESH | Anti-Bacterial Agents | - |
dc.subject.MESH | Antimicrobial Stewardship* | - |
dc.subject.MESH | Humans | - |
dc.subject.MESH | Inpatients | - |
dc.subject.MESH | Intensive Care Units | - |
dc.title | Use of antimicrobial agents in actively dying inpatients after suspension of life-sustaining treatments: Suggestion for antimicrobial stewardship | - |
dc.type | Article | - |
dc.contributor.college | College of Medicine (의과대학) | - |
dc.contributor.department | Dept. of Internal Medicine (내과학교실) | - |
dc.contributor.googleauthor | Dayeong Kim | - |
dc.contributor.googleauthor | Subin Kim | - |
dc.contributor.googleauthor | Kyoung Hwa Lee | - |
dc.contributor.googleauthor | Sang Hoon Han | - |
dc.identifier.doi | 10.1016/j.jmii.2022.03.003 | - |
dc.contributor.localId | A04286 | - |
dc.contributor.localId | A04620 | - |
dc.relation.journalcode | J01595 | - |
dc.identifier.eissn | 1995-9133 | - |
dc.identifier.pmid | 35365408 | - |
dc.subject.keyword | Actively dying patient | - |
dc.subject.keyword | Advance directives | - |
dc.subject.keyword | Antibiotics | - |
dc.subject.keyword | Antimicrobial stewardship | - |
dc.subject.keyword | Life-sustaining treatment | - |
dc.subject.keyword | Suspension | - |
dc.contributor.alternativeName | Han, Sang Hoon | - |
dc.contributor.affiliatedAuthor | 한상훈 | - |
dc.contributor.affiliatedAuthor | 이경화 | - |
dc.citation.volume | 55 | - |
dc.citation.number | 4 | - |
dc.citation.startPage | 651 | - |
dc.citation.endPage | 661 | - |
dc.identifier.bibliographicCitation | JOURNAL OF MICROBIOLOGY IMMUNOLOGY AND INFECTION, Vol.55(4) : 651-661, 2022-08 | - |
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