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

Kim, ﻿Dayeong; Kim, Subin; Lee, Kyoung Hwa; Han, Sanghoon

doi:10.1016/j.jmii.2022.03.003

Cited by 5 publications

(2 citation statements)

References 69 publications

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“…In 2006, one study reported that 84.4% of terminal cancer patients received antibiotics within a month of their death, with 63.8% continuing to receive antibiotics until their last day [ 1 ]. Another study found that 90.6% of patients continued to receive antibiotics after their POLST decision and 60.1% received antibiotic combination treatment [ 8 ]. A recent nationwide multicenter cohort study found that 88.9% of terminally ill patients received antimicrobial agents during the last two weeks of their lives [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Antibiotics use patterns in end-of-life cancer patients and medical staff’s perception of antimicrobial stewardship programs

Kwon,

Jung,

Choi

et al. 2023

Korean J Intern Med

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Background/Aims: While most cancer patients with end-of-life (EOL) care receive antibiotic treatments, antibiotic use should be decided appropriately considering the benefits, side effects, resistance, and cost effects. Antimicrobial stewardship programs (ASP) are important for patients with EOL care, but there is limited study analyzing actual antibiotic use in EOL care and the perceptions of Korean medical staff.Methods: Electronic medical records of 149 deceased cancer patients hospitalized in the medical hospitalist units at Asan Medical Center in Seoul from May 2019 to September 2021 were reviewed. Basic information, antibiotic use, duration, and changes were investigated. We surveyed medical staff’s perceptions of antibiotics in cancer patients with EOL.Results: Of the 149 cancer patients with EOL care, 146 (98.0%) agreed with physician orders for life-sustaining treatment (POLST). In total, 143 (95.9%) received antibiotics, 110 (76.9%) received combination antibiotic treatment, and 116 (81.1%) were given antibiotics until the day of death. In a survey of 60 medical staff, 42 (70.0%) did not know about ASP, and 24 (40.0%) thought ASP was important in EOL care. Nineteen doctors (31.7%) discussed the use or discontinuation of antibiotics with patients or caregivers when writing POLST, but only 8 patients (5.6%) stopped antibiotics after POLST.Conclusions: Most cancer patients with EOL care continue to receive antibiotics until just before their death. A careful approach is needed, considering the benefits and side effects of antibiotic use, and the patient’s right to self-decision. It is necessary to actively improve awareness of ASP and its importance for medical staff.

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Section: Introductionmentioning

confidence: 99%

Antibiotics use patterns in end-of-life cancer patients and medical staff’s perception of antimicrobial stewardship programs

Kwon,

Jung,

Choi

et al. 2023

Korean J Intern Med

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“… 6 In a 2-center study of 1,296 inpatients on withholding or withdrawing life-sustaining treatment (WLST), 90.6% of those who died received antibiotic therapy within 7 days before death. 7 …”

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confidence: 99%

Analysis of microbiological tests in patients withholding or withdrawing life-sustaining treatment at the end stage of life in 2 Korean hospitals

Bae,

Kwon,

Hwang

et al. 2023

Infect. Control Hosp. Epidemiol.

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Objective: We evaluated the adequacy of microbiological tests in patients withholding or withdrawing life-sustaining treatment (WLST) at the end stage of life. Setting: The study was conducted at 2 tertiary-care referral hospitals in Daegu, Republic of Korea. Design: Retrospective cross-sectional study. Methods: 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. Results: 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. Candida spp. were the most common microbiological species in sputum (17.4%) and urine (48.2%), and Acinetobacter 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. Conclusions: 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.

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An Approach to Caring for Patients and Family of Patients Dying in the ICU

Jennerich

2024

CHEST

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

Cited by 5 publications

References 69 publications

Antibiotics use patterns in end-of-life cancer patients and medical staff’s perception of antimicrobial stewardship programs

Antibiotics use patterns in end-of-life cancer patients and medical staff’s perception of antimicrobial stewardship programs

Analysis of microbiological tests in patients withholding or withdrawing life-sustaining treatment at the end stage of life in 2 Korean hospitals

An Approach to Caring for Patients and Family of Patients Dying in the ICU

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