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DC Field | Value | Language |
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dc.contributor.author | Kim, Dayeong | - |
dc.contributor.author | Kim, Subin | - |
dc.contributor.author | Hwa Lee, Kyoung | - |
dc.contributor.author | Hoon Han, Sang | - |
dc.date.accessioned | 2024-12-19T02:42:19Z | - |
dc.date.available | 2024-12-19T02:42:19Z | - |
dc.date.issued | 2022-08-01 | - |
dc.identifier.issn | 1684-1182 | - |
dc.identifier.uri | http://localhost:8080/xmlui/handle/123456789/9276 | - |
dc.description.abstract | 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 Antibacterial and antifungal agents were withdrawn in only 8.3% and 1.3% of the patients after SLST, respectively.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 SLSTConclusions: 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. | en_US |
dc.language.iso | en | en_US |
dc.publisher | Elsevier Taiwan LLC | en_US |
dc.subject | Actively dying patient; | en_US |
dc.subject | Advance directives; | en_US |
dc.subject | Antibiotics; | en_US |
dc.subject | Antimicrobial stewardship; | en_US |
dc.subject | Life-sustaining treatment; | en_US |
dc.subject | Suspension | en_US |
dc.title | Use of antimicrobial agents in actively dying inpatients after suspension of life-sustaining treatments: Suggestion for antimicrobial stewardship | en_US |
dc.type | Article | en_US |
Appears in Collections: | VOL 55 NO 4 2022 |
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651-661.pdf | 381.36 kB | Adobe PDF | View/Open |
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