Preprint Communication Version 1 Preserved in Portico This version is not peer-reviewed

The Utilization of Carbapenem Use within the Last Days of Life: A Korean Nationwide Study

Version 1 : Received: 21 April 2023 / Approved: 23 April 2023 / Online: 23 April 2023 (02:35:08 CEST)

A peer-reviewed article of this Preprint also exists.

Wi, Y.M.; Kwon, K.T.; Jeon, C.-H.; Kim, S.-H.; Hwang, S.; Bae, S.; Kim, Y.; Chang, H.-H.; Kim, S.-W.; Cheong, H.S.; Lee, S.; Jung, D.S.; Sohn, K.M.; Moon, C.; Heo, S.T.; Kim, B.; Lee, M.S.; Hur, J.; Kim, J.; Yoon, Y.K.; Antimicrobial Stewardship Research Committee of Korean Society for Antimicrobial Therapy. Carbapenem Use in the Last Days of Life: A Nationwide Korean Study. Antibiotics 2023, 12, 964. Wi, Y.M.; Kwon, K.T.; Jeon, C.-H.; Kim, S.-H.; Hwang, S.; Bae, S.; Kim, Y.; Chang, H.-H.; Kim, S.-W.; Cheong, H.S.; Lee, S.; Jung, D.S.; Sohn, K.M.; Moon, C.; Heo, S.T.; Kim, B.; Lee, M.S.; Hur, J.; Kim, J.; Yoon, Y.K.; Antimicrobial Stewardship Research Committee of Korean Society for Antimicrobial Therapy. Carbapenem Use in the Last Days of Life: A Nationwide Korean Study. Antibiotics 2023, 12, 964.

Abstract

The appropriate carbapenem use is a critical concern for patient safety, public health, and 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 comprising of 1,350 decedents. Carbapenem use was universally restricted by computerised authorisation 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 2 weeks of their lives, of whom 533 (44.4%) received at least one carbapenem. The median carbapenem treatment duration was 7 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%) were referred to infectious disease (ID) specialists. Of the 333 patients (62.5%) without ID consults, 194 (58.2%) were assessed as “not optimal”: 79 (23.7%) required escalation, 100 (30.0%) required de-escalation, and 15 (4.5%) discontinued. Notwithstanding the existing antibiotic restriction program system, carbapenems are commonly prescribed to patients within their last days of life, a majority of whom do not require it.

Keywords

handshake; carbapenem; antimicrobial stewardship programs

Subject

Medicine and Pharmacology, Epidemiology and Infectious Diseases

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