Long-term effect of computer-assisted decision support for antibiotic treatment in critically ill patients: a prospective ‘before/after’ cohort study

Nachtigall, Irit; Tafelski, Sascha; Deja, Maria; Halle, E.; Grebe, Markus; Tamarkin, Andrey; Rothbart, Andreas; Uhrig, Alexander; Meyer, Elisabeth; Musial-Bright, Lindy; Wernecke, KD; Spies, Claudia

doi:10.1136/bmjopen-2014-005370

Cited by 54 publications

(41 citation statements)

References 30 publications

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“…Adherence to guidelines 24 was recorded and assessed on a daily basis while data collection took place. The following points, alone or in combination, were regarded as guideline discrepancies: missing attention to prior antibiotic regimen, insufficient diagnostic proceedings, delayed antibiotic application, unsuitable combinations, missing combination partner or inappropriate antibiotic, lacking indication, and neglect of deescalation strategies.…”

Section: Data Collection and Measurementmentioning

confidence: 99%

Effect of blood-sugar limitation on intensive care mortality: Intragroup evaluation

et al. 2015

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Objective: To evaluate the safety profile of blood sugar limits in intensive care unit (ICU) patients. Methods: Adult patients with ICU stay >36 h, more than two blood sugar measurements and antibiotic therapy concordant with locally adapted guidelines were included. For analyses, one study cohort was defined in two ways: as a narrow group, euglycaemic patients' blood sugar levels 80-150 mg/dl; as a moderate group, euglycaemic patients' blood sugar levels 80-180 mg/dl. Dysglycaemia was defined as blood sugar levels <80 mg/dl for >5% of measurements, and >150 mg/dl or >180 mg/dl (narrow or moderate groups, respectively) for >10% of measurements. The primary endpoint was ICU mortality (euglycaemia versus dysglycaemia). Results: The study comprised 668 patients. When defined as a narrow group, ICU mortality was 3% (four of 135) euglycaemic versus 10% (54/533) dysglycaemic patients (odds ratio [OR] 3.692, 95% confidence interval [CI] 1.313, 10.382). When defined as a moderate group, ICU mortality was 6% (21/351) euglycaemic versus 12% (37/317) dysglycaemic patients (OR 2.077, 95% CI 1.188, 3.630). Frequency of severe hypoglycaemia (blood sugar <40 mg/dl) was not different between the narrow and moderate euglycaemic ranges. Conclusions: Euglycaemia was associated with lower ICU mortality than dysglycaemia, and incidence of hypoglycaemia was low overall in this study. Based on current published evidence, therapeutic targets should be defined according to individual patient characteristics.

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Section: Data Collection and Measurementmentioning

confidence: 99%

Effect of blood-sugar limitation on intensive care mortality: Intragroup evaluation

et al. 2015

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“…[5][6][7][8][9][10] Evidence for the benefits of AMS functionality within e-prescribing systems comes from published research studies demonstrating positive impact on outcomes including increased guideline adherence 11,12 and effective initial therapy 13 or reductions in antimicrobial prescribing, 14,15 resistance, 16,17 dosing errors, 8 length of hospital or ICU stay 14,18 and mortality. 12,13,19 However, many of these information systems were created on a small scale in individual hospitals or groups of institutions and few reports cover the full potential range of software features that enable AMS.…”

mentioning

confidence: 99%

Electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 UK infection specialists

Hand

Cumming

Hopkins

et al. 2016

J. Antimicrob. Chemother.

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SynopsisThe implementation of electronic prescribing and medication administration systems (EPMAs) is a priority for hospitals and a potential component of antimicrobial stewardship (AMS). ObjectivesThis study aimed to identify software features within EPMAs that could potentially facilitate AMS and to survey practising UK infection specialist healthcare professionals in order to assign priority to these software features. MethodsA questionnaire was developed using nominal group technique and transmitted via email links through professional networks. The questionnaire collected demographic data, information on priority areas and anticipated impact of EPMA. Responses from different respondent groups were compared using the Mann Whitney U test. ResultsResponses were received from 164 individuals (142 analysable). Respondents were predominantly specialist infection pharmacists (48%) or medical microbiologists (37%). 59% of pharmacists had experience of EPMA in their hospitals compared to 35% of microbiologists. Pharmacists assigned higher priority to: indication prompt (p<0.001), allergy checker (p=0.003) treatment protocols (p=0.003), drug-indication mismatch alerts (p=0.031) and prolonged course alerts (p=0.041); and lower priority to a dose checker for adults (p=0.02) and an interaction checker (p<0.05), than microbiologists. A "soft stop" functionality was rated essential or a high priority by 89% of respondents. Potential EPMA software features were expected to have the greatest impact on stewardship, treatment efficacy and patient safety outcomes with lowest impact on Clostridium difficile infection (CDI), antimicrobial resistance and drug expenditure. ConclusionsThe survey demonstrates key differences in health professionals' opinions of different healthcare benefits of EPMA but a consensus of anticipated positive impact on patient safety and antimicrobial stewardship.

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“…Median ICU stay was 16 days (25-75% quartiles: 8-35) in the intermittent group versus 20 days (25-75% quartiles: [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] in the continuous group (p = 0.729). The duration of ventilation also did not show differences, with 256 h (25-75% quartiles: 31-748) in the intermittent group versus 365 h (25-75% quartiles: 99-569) in the continuous population (p = 0.424).…”

Section: Clinical Course Of Patientsmentioning

confidence: 99%

“…For all study wards, therapeutic and diagnostic recommendations regarding anti-infective therapy are implemented based on a computerized decisionsupport system called ABx [15,17,18]. This program also provides detailed information for dosing and therapeutic drug monitoring (TDM) for vancomycin (see Table 1).…”

Section: Therapeutic Drug Monitoring (Tdm) For Vancomycinmentioning

confidence: 99%

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Observational clinical study on the effects of different dosing regimens on vancomycin target levels in critically ill patients: Continuous versus intermittent application

Tafelski¹,

Nachtigall²,

Troeger³

et al. 2015

Journal of Infection and Public Health

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Different dosing regimens for vancomycin are in clinical use: intermittent infusion and continuous administration. The intention of using these different dosing regimens is to reduce toxicity, to achieve target levels faster and to avoid treatment failure. The aim of this phase IV study was to compare safety and effectiveness in both administration regimens. The study was conducted in 2010 and 2011 in three postoperative intensive care units (ICUs) in a tertiary care university hospital in Berlin, Germany. Adult patients with vancomycin therapy and therapeutic drug monitoring were included. Out of 675 patients screened, 125 received vancomycin therapy, 39% with intermittent and 61% with continuous administration. Patients with continuous administration achieved target serum levels significantly earlier (median day 3 versus 4, p=0.022) and showed fewer sub-therapeutic serum levels (41% versus 11%, p<0.001). ICU mortality rate, duration of ICU stay and duration of ventilation did not differ between groups. Acute renal failure during the ICU stay occurred in 35% of patients with intermittent infusion versus 26% of patients with continuous application (p=0.324). In conclusion, continuous administration of vancomycin allowed more rapid achievement of targeted drug levels with fewer sub-therapeutic vancomycin levels observed. This might indicate that patients with more severe infections or higher variability in renal function could benefit from this form of administration.

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Long-term effect of computer-assisted decision support for antibiotic treatment in critically ill patients: a prospective ‘before/after’ cohort study

Cited by 54 publications

References 30 publications

Effect of blood-sugar limitation on intensive care mortality: Intragroup evaluation

Effect of blood-sugar limitation on intensive care mortality: Intragroup evaluation

Electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 UK infection specialists

Observational clinical study on the effects of different dosing regimens on vancomycin target levels in critically ill patients: Continuous versus intermittent application

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