Computerized antimicrobial decision support: an offline evaluation of a database-driven empiric antimicrobial guidance program in hospitalized patients with a bloodstream infection

Mullett, Charles J.; Thomas, John G.; Smith, Connie L.; Sarwari, Arif R.; Khakoo, Rashida

doi:10.1016/j.ijmedinf.2004.04.002

Cited by 26 publications

(15 citation statements)

References 10 publications

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“…[1,5,18–31] Adequacy of antibiotic coverage was defined in individual studies and included retrospective review of antibiotic recommendations made by CDS systems and measures of prescriber compliance with published guidelines when CDS was in use. Thirteen of these contained sufficient information to be included in the meta-analysis [1,5,18,21,23–31], ten of which (1, 22, 24–27, 29–32) reported a statistically significant effect of CDS on the adequacy of antibiotic coverage. Three studies were not included in the meta-analysis since they presented insufficient data to allow pooling of outcomes.…”

Section: Resultsmentioning

confidence: 99%

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

2017

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BackgroundInappropriate antimicrobial use has been shown to be an important determinant of the emergence of antimicrobial resistance (AMR). Health information technology (HIT) in the form of Computerised Decision Support (CDS) represents an option for improving antimicrobial prescribing and containing AMR.ObjectivesTo evaluate the evidence for CDS in improving quantitative and qualitative measures of antibiotic prescribing in inpatient hospital settings.MethodsA systematic literature search was conducted of articles published from inception to 20th December 2014 using eight electronic databases: MEDLINE, EMBASE, PUBMED, Web of Science, CINAHL, Cochrane Library, HMIC and PsychINFo. An updated systematic literature search was conducted from January 1st 2015 to October 1st 2016 using PUBMED. The search strategy used combinations of the following terms: (electronic prescribing) OR (clinical decision support) AND (antibiotic or antibacterial or antimicrobial) AND (hospital or secondary care or inpatient). Studies were evaluated for quality using a 10-point rating scale.ResultsEighty-one studies were identified matching the inclusion criteria. Seven outcome measures were evaluated: adequacy of antibiotic coverage, mortality, volume of antibiotic usage, length of stay, antibiotic cost, compliance with guidelines, antimicrobial resistance, and CDS implementation and uptake. Meta-analysis of pooled outcomes showed CDS significantly improved the adequacy of antibiotic coverage (n = 13; odds ratio [OR], 2.11 [95% CI, 1.67 to 2.66, p ≤ 0.00001]). Also, CDS was associated with marginally lowered mortality (n = 20; OR, 0.85 [CI, 0.75 to 0.96, p = 0.01]). CDS was associated with lower antibiotic utilisation, increased compliance with antibiotic guidelines and reductions in antimicrobial resistance. Conflicting effects of CDS on length of stay, antibiotic costs and system uptake were also noted.ConclusionsCDS has the potential to improve the adequacy of antibiotic coverage and marginally decrease mortality in hospital-related settings.

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Section: Resultsmentioning

confidence: 99%

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

2017

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“…2000). Mullett et al . (2004) also reported that a computerized antimicrobial decision support programme based on past patient demographic data, and culture results had improved the rate of effectiveness of empiric antimicrobial therapy for bacteremia patients by 20%.…”

Section: Discussionmentioning

confidence: 99%

Clinical prediction rules for bacteremia and in‐hospital death based on clinical data at the time of blood withdrawal for culture: an evaluation of their development and use

Nakamura

Takahashi

Matsui

et al. 2006

Evaluation Clinical Practice

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“…These include computer decision support 61 Computer-assisted decision support has been shown to improve or reduce antibiotic-susceptibility mismatches (improve selection of effective therapy), overall antibiotic use, excess antimicrobial dosages, excessive-dose days, selection of antimicrobials for which the patient was poorly matched in terms of allergies, and antimicrobial-related adverse events, as well as reduce antimicrobial drug costs, total hospital costs, and length of hospital stay. [72][73][74][75][76][77] For their part, CPOE systems have been shown to improve compliance with treatment guidelines, decrease medication and other medical errors, shorten length of hospital stay, and decrease pharmaceutical costs. 66,67,78 In many cases, CPOE systems can now be modified to include some clinical decision support to improve antimicrobial use.…”

Section: Supplemental Strategiesmentioning

confidence: 99%

Antimicrobial stewardship for inpatient facilities

Ohl

Luther

2011

Journal of Hospital Medicine

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Antibiotic stewardship aims to improve patient care and reduce unwanted consequences of antimicrobial overuse or misuse, including lowered efficacy, emergence of antimicrobial resistance, development of secondary infections, adverse drug reactions, increased length of hospital stay, and additional healthcare costs. Recent guidelines make specific recommendations for the development of institutional programs to enhance antimicrobial stewardship. Optimally, such programs should be comprehensive, multidisciplinary, supported by hospital and medical staff leadership, and should employ evidence‐based strategies that best fit local needs and resources. An infectious diseases physician and clinical pharmacist with infectious diseases training are recommended as core members of the multidisciplinary team, although a hospitalist with interest (and perhaps additional training) in antimicrobial therapy may be able to fill the void. Program directors and core members should be compensated for their time. Principal proactive strategies—with evidence supporting their consideration—include prospective audits, with intervention and feedback, formulary restriction, and preauthorization. Other strategies include persistent one‐on‐one education, guidelines adapted to local needs, and informatics to support clinical decision making. Intervention goals are to prevent unnecessary antimicrobial starts, to streamline or de‐escalate therapy early in its course, and to convert from parenteral to oral therapy, optimize dosing, and ensure the appropriate length of therapy. Most community hospitals, if sufficiently resourced, should be able to implement a successful antimicrobial stewardship program. Evidence suggests that good antimicrobial stewardship can lead to less overall and inappropriate antimicrobial use, lower drug‐related costs, reductions in Clostridium difficile–associated disease, and, in some studies, less emergence of antimicrobial resistance. Journal of Hospital Medicine 2011;6:S4‐S15 ©2011 Society of Hospital Medicine.

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Computerized antimicrobial decision support: an offline evaluation of a database-driven empiric antimicrobial guidance program in hospitalized patients with a bloodstream infection

Cited by 26 publications

References 10 publications

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

Clinical prediction rules for bacteremia and in‐hospital death based on clinical data at the time of blood withdrawal for culture: an evaluation of their development and use

Antimicrobial stewardship for inpatient facilities

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