Carbapenem Use in the Last Days of Life: A Nationwide Korean Study
Yu Mi Wi,
Ki Tae Kwon,
Cheon-Hoo Jeon,
Si-Ho Kim,
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,
Antimicrobial Stewardship Research Committee of Korean Society for Antimicrobial Therapy
Affiliations
Yu Mi Wi
Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea
Ki Tae Kwon
Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu 41404, Republic of Korea
Cheon-Hoo Jeon
Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea
Si-Ho Kim
Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea
Soyoon Hwang
Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu 41404, Republic of Korea
Sohyun Bae
Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
Yoonjung Kim
Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
Hyun-Ha Chang
Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
Shin-Woo Kim
Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
Hae Suk Cheong
Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
Shinwon Lee
Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan 50612, Republic of Korea
Dong Sik Jung
Department of Internal Medicine, Dong-A University College of Medicine, Busan 49201, Republic of Korea
Kyung Mok Sohn
Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
Chisook Moon
Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Busan 47392, Republic of Korea
Sang Taek Heo
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Jeju National University, Jeju 63241, Republic of Korea
Bongyoung Kim
Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
Mi Suk Lee
Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, Republic of Korea
Jian Hur
Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea
Jieun Kim
Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
Young Kyung Yoon
Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Republic of Korea
Antimicrobial Stewardship Research Committee of Korean Society for Antimicrobial Therapy
The appropriate use of carbapenem is a critical concern for patient safety and public health, and is a national priority. We investigated the nationwide status of carbapenem prescription in patients within their last 14 days of life to guide judicious-use protocols from the previous study comprised of 1350 decedents. Carbapenem use was universally controlled through computerised authorisation system at all centres during the study period. Carbapenem prescribing patterns and their optimality were evaluated. A total of 1201 patients received antimicrobial agents within the last two weeks of their lives, of whom 533 (44.4%) received at least one carbapenem. The median carbapenem treatment duration was seven days. Of the 533 patients receiving carbapenems, 510 (95.7%) patients had microbiological samples drawn and 196 (36.8%) yielded carbapenem-resistant pathogens. A total of 200 (37.5%) patients were referred to infectious disease (ID) specialists. Of the 333 patients (62.5%) who did not have ID consultations, 194 (58.2%) were assessed as “not optimal”, 79 (23.7%) required escalation, 100 (30.0%) required de-escalation, and 15 (4.5%) were discontinued. Notwithstanding the existing antibiotic restriction program system, carbapenems are commonly prescribed to patients in their last days of life.