title: Frequent Prescription of Antibiotics and High Burden of Antibiotic Resistance among Deceased Patients in General Medical Wards of Acute Care Hospitals in Korea.
abstract: BACKGROUND
  Antibiotics are often administered to terminally ill patients until death, and antibiotic use contributes to the emergence of multidrug-resistant organisms (MDROs). We investigated antibiotic use and the isolation of MDROs among patients who died in general medical wards.
  
  
  METHODS
  All adult patients who died in the general internal medicine wards at four acute care hospitals between January and June 2013 were enrolled. For comparison with these deceased patients, the same number of surviving, discharged patients was selected from the same divisions of internal medicine subspecialties during the same period.
  
  
  RESULTS
  During the study period, 303 deceased patients were enrolled; among them, 265 (87.5%) had do-not-resuscitate (DNR) orders in their medical records. Antibiotic use was more common in patients who died than in those who survived (87.5% vs. 65.7%, P<0.001). Among deceased patients with DNR orders, antibiotic use was continued in 59.6% of patients after obtaining their DNR orders. Deceased patients received more antibiotic therapy courses (two [interquartile range (IQR) 1-3] vs. one [IQR 0-2], P<0.001). Antibiotics were used for longer durations in deceased patients than in surviving patients (13 [IQR 5-23] vs. seven days [IQR 0-18], P<0.001). MDROs were also more common in deceased patients than in surviving patients (25.7% vs. 10.6%, P<0.001).
  
  
  CONCLUSIONS
  Patients who died in the general medical wards of acute care hospitals were exposed to more antibiotics than patients who survived. In particular, antibiotic prescription was common even after obtaining DNR orders in patients who died. The isolation of MDROs during the hospital stay was more common in these patients who died. Strategies for judicious antibiotic use and appropriate infection control should be applied to these patient populations.
authors.affiliation: Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
authors.forename: Yee Gyung
authors.initials: YG
authors.lastname: Kwak
authors.affiliation: Department of Internal Medicine, Inje University Busan-Paik Hospital, Busan, Republic of Korea.
authors.forename: Chisook
authors.initials: C
authors.lastname: Moon
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Eu Suk
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Seoul, Republic of Korea.
authors.forename: Baek-Nam
authors.initials: BN
authors.lastname: Kim
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D017281:Cost of Illness; D003643:Death; D004352:Drug Resistance, Microbial / Q000187:drug effects*; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010362:Patients' Rooms; D055656:Prescriptions; D056910:Republic of Korea
chemical_list: D000900:Anti-Bacterial Agents