All the antimicrobial agents were included in the analysis. Patients receiving topical, ophthalmic, or otic antibiotics were excluded from the study. The amount of antimicrobial agents was measured by the days of therapy (DOT) and standardized for 1,000 patient-days. The Life-Sustaining Treatment Decision Act makes withholding and withdrawing LST possible using the legal determination form.20 This legal determination form is intended for patients with “serious chronic or acute illness nearing the end stages or likely to progress to a life-threatening state suddenly”. LST was defined as CPR, MV support, renal replacement therapy, chemotherapy, extracorporeal membrane oxygenation, transfusion, and use of inotropes. The form can be completed by any patient at any time or by the patient’s relative according to the Act. The completion of the LST form was divided into an LST form completed ≤ 14 days prior to death and an LST form completed > 14 days prior to death. ID specialists in each participating hospital assessed the antibiotic prescription as needing escalation, de-escalation, continuing, discontinuing or not assessable. Cases assessed as “Needing to continue” were considered appropriate antibiotic prescriptions, and other assessments were classified as inappropriate antibiotic prescriptions. Multidrug resistant (MDR) organisms include multidrug-resistant Acinetobacter baumannii (MRAB), vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, multidrug-resistant Pseudomonas aeruginosa (MRPA), and carbapenem-resistant Enterobacteriaceae (CRE).