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Use of Antibiotics Within the Last 14 Days of Life in Korean Patients: A Nationwide Study
위유미,권기태,황소윤,배소현,김윤정,Chang Hyun-Ha,김신우,Cheong Hae Suk,이신원,정동식,손경목,문치숙,Heo Sang Taek,김봉영,이미숙,Hur Jian,김지은,윤영경 대한의학회 2023 Journal of Korean medical science Vol.38 No.9
Background: Antimicrobial prescriptions for serious chronic or acute illness nearing its end stages raise concerns about the potential for futile use, adverse events, increased multidrugresistant organisms, and significant patient and social cost burdens. This study investigated the nationwide situation of how antibiotics are prescribed to patients during the last 14 days of life to guide future actions. Methods: This nationwide multicenter retrospective cohort study was conducted at 13 hospitals in South Korea from November 1 to December 31, 2018. All decedents were included in the study. Antibiotic use during the last two weeks of their lives was investigated. Results: A total of 1,201 (88.9%) patients received a median of two antimicrobial agents during the last two weeks of their lives. Carbapenems were prescribed to approximately half of the patients (44.4%) in the highest amount (301.2 days of therapy per 1,000 patient-days). Among the patients receiving antimicrobial agents, 63.6% were inappropriate and only 327 patients (27.2%) were referred by infectious disease specialists. The use of carbapenem (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.13–2.03; P = 0.006), underlying cancer (OR, 1.56; 95% CI, 1.20–2.01, P = 0.047), underlying cerebrovascular disease (OR, 1.88; 95% CI, 1.23–2.89, P = 0.004), and no microbiological testing (OR, 1.79; 95% CI, 1.15–2.73; P = 0.010) were independent predictors for inappropriate antibiotic prescribing. Conclusion: A considerable number of antimicrobial agents are administered to patients with chronic or acute illnesses nearing their end-of-life, a high proportion of which are prescribed inappropriately. Consultation with an infectious disease specialist, in addition to an antimicrobial stewardship program, may be necessary to induce the optimal use of antibiotics.
위유미 ( Yu Mi Wi ),강철인 ( Cheol-in Kang ) 대한내과학회 2018 대한내과학회지 Vol.93 No.5
Carbapenem-resistance emerging in Gram-negative pathogens, such as Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii, has become a major human health problem globally. The therapeutic options available for carbapenem- resistant pathogens are very limited. Antibiotics such as colistin, tigecycline, fosfomycin, and aminoglycosides are often the only ones that can be used to treat carbapenem-resistant pathogens. Carbapenem may still be an option in certain circumstances. The administration of combination therapy for carbapenem-resistant pathogens is controversial. This review presents the current knowledge of available antimicrobial therapeutic options for infections due to carbapenem-resistant pathogens in Korea. (Korean J Med 2018;93:439-446)
급성기 의료기관의 C. difficile 감염관리 전략과 전망
김시호,위유미 대한의료관련감염관리학회 2021 의료관련감염관리 Vol.26 No.2
Clostridium difficile is a spore-forming anaerobic gram-positive bacillus. With increasing antibiotic use, changing patient population, and microbiological characteristics of C. difficile, this pathogen has emerged as one of the most challenging pathogens of nosocomial infections. The current important strategies for preventing C. difficile infection (CDI) are patient monitoring, early recognition (prompt and accurate diagnosis accompanied by an appropriate diagnostic algorithm and a CDI surveillance system), blocking transmission (contact isolation, hand washing, environmental disinfection, and cleaning), and controlling risk factors (increasing the appropriateness of antibiotic use through antibiotic stewardship program). In this review, we will reappraise the clinical efficacy and efficiency of each strategy for preventing CDI and introduce promising interventions for CDI prevention.