{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:30:39Z","timestamp":1790739039189,"version":"4.1.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Patients with advanced cancer frequently receive broad-spectrum antibiotics, but changing use patterns across the end-of-life trajectory remain poorly understood.<\/jats:p><\/jats:sec>Objective<\/jats:title>To describe the patterns of broad-spectrum antibiotic use across defined end-of-life intervals in patients with advanced cancer.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This nationwide, population-based, retrospective cohort study used data from the South Korean National Health Insurance Service database to examine broad-spectrum antibiotic use among patients with advanced cancer who died between July 1, 2002, and December 31, 2021. Data extraction and analysis were conducted between September 2023 and August 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>A diagnosis of lung cancer, liver cancer, stomach cancer, colorectal cancer, pancreatic cancer, prostate cancer, gallbladder and biliary tract cancer, breast cancer, non-Hodgkin lymphoma, leukemia, or multiple myeloma.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The use of broad-spectrum antibiotics (ie, antipseudomonal \u03b2-lactams, carbapenems, or glycopeptides) was evaluated using 2 metrics according to end-of-life trajectory: (1) prescription proportion (percentage of patients receiving antibiotics) and (2) consumption amount (days of therapy per 1000 patient-days). The end-of-life trajectory was divided into 5 intervals: T1 (6 months to 3 months before death), T2 (3 months to 1 month before death), T3 (1 month to 2 weeks before death), T4 (2 weeks to 1 week before death), and T5 (final week before death). Logistic regression was performed to calculate odds ratios and 95% CIs for antibiotic prescription proportion without adjustment for multiple comparisons, and Poisson regression was used to calculate adjusted relative risks.<\/jats:p><\/jats:sec>Results<\/jats:title>Among the 515\u202f366 decedents included, the mean (SD) age was 68.8 (11.7) years, and 347\u202f327 (67.4%) were male. A total of 483\u202f405 patients (93.8%) had solid tumors, with lung cancer (122\u202f142 patients [23.7%]) being the most common type. Overall, 288\u202f151 patients (55.9%) received broad-spectrum antibiotics during the last 6 months of life. The proportion of patients receiving broad-spectrum antibiotics peaked during T2, with 144\u202f920 (28.1%) receiving at least 1 dose, and declined to 68\u202f564 (13.3%) during T5. In contrast, total consumption peaked during T3, reaching 190.0 days of therapy per 1000 patient-days. These patterns were consistent across antibiotic classes and cancer types. During the last week of life, patients with leukemia had the highest exposure to broad-spectrum antibiotics compared with those with lung cancer, both for prescription proportions (crude odds ratio, 1.50; 95% CI, 1.43-1.58) and total consumption (adjusted relative risk, 1.21; 95% CI, 1.19-1.23).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of patients with advanced cancer, broad-spectrum antibiotic use increased from 3 months to 2 weeks before death, suggesting that this may be a key period for optimizing use and aligning care with patient goals.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.30980","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T15:00:20Z","timestamp":1757430020000},"page":"e2530980","source":"Crossref","is-referenced-by-count":7,"title":["Broad-Spectrum Antibiotic Use at the End of Life in Patients With Advanced Cancer"],"prefix":"10.1001","volume":"8","author":[{"given":"Jeong-Han","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Ewha Woman University College of Medicine, Mokdong Hospital, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiwon","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Artificial Intelligence Convergence, Hallym University, Chuncheon, South Korea"},{"name":"Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin Hye","family":"Yoo","sequence":"additional","affiliation":[{"name":"Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, South Korea"},{"name":"Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, South 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