Improving empirical antibiotic treatment using TREAT, a computerized decision support system: cluster randomized trial
Mical Paul,Steen Andreassen,Evelina Tacconelli,Anders Møller Nielsen,N. Almanasreh,Uwe Frank,Roberto Cauda,Leonard Leibovici +7 more
TLDR
TREAT improved the rate of appropriate empirical antibiotic treatment while reducing antibiotic costs and the use of broad-spectrum antibiotic treatment.Abstract:
Background: Appropriate antibiotic treatment decreases mortality, while superfluous treatment is associated with antibiotic resistance. We built a computerized decision support system for antibiotic treatment (TREAT) targeting these outcomes. Methods: Prospective cohort study comparing TREAT’s advice to physician’s treatment followed by a cluster randomized trial comparing wards using TREAT (intervention) versus antibiotic monitoring without TREAT (control). We included patients suspected of harbouring bacterial infections in three hospitals (Israel, Germany and Italy). The primary outcome, appropriate antibiotic treatment, was assessed among patients with microbiologically documented infections (MDI). Length of hospital stay, adverse events, mortality (interventional trial) and antibiotic costs (both studies), including costs related to future antibiotic resistance, were compared among all included patients. Results: Among 1203 patients included in the cohort study (350 with MDI), TREAT prescribed appropriate empirical antibiotic treatment significantly more frequently than physicians (70% versus 57%, P < 0.001) using less broad-spectrum antibiotics at half physicians’ antibiotic costs. The randomized trial included 2326 patients, 570 with MDI. The rate of appropriate empirical antibiotic treatment was higher in intervention versus control wards [73% versus 64%, odds ratio (OR): 1.48, 95% confidence interval (CI): 0.95–2.29, intention to treat, adjusted for location and clustering]. For patients treated according to TREAT’s advice in intervention wards, the difference with controls was highly significant (OR: 3.40, 95% CI: 2.25–5.14). Length of hospital stay, costs related to future resistance and total antibiotic costs were lower in intervention versus control wards. Conclusions: TREAT improved the rate of appropriate empirical antibiotic treatment while reducing antibiotic costs and the use of broad-spectrum antibiotic treatment.read more
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Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America
Tamar F. Barlam,Tamar F. Barlam,Sara E. Cosgrove,Lilian M. Abbo,Conan MacDougall,Audrey N. Schuetz,Edward Septimus,Arjun Srinivasan,Timothy H. Dellit,Yngve Falck-Ytter,Neil O. Fishman,Cindy W. Hamilton,Timothy C. Jenkins,Pamela A. Lipsett,Preeti N. Malani,Larissa S May,Gregory J. Moran,Melinda M. Neuhauser,Jason G. Newland,Christopher A. Ohl,Matthew H. Samore,Susan K. Seo,Kavita K. Trivedi +22 more
TL;DR: These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics.
Journal ArticleDOI
Interventions to improve antibiotic prescribing practices for hospital inpatients
Peter Davey,Charis Marwick,Claire Scott,Esmita Charani,Kirsty McNeil,Erwin M. Brown,Ian M. Gould,Craig R Ramsay,Susan Michie +8 more
TL;DR: This systematic review of interventions to improve antibiotic prescribing to hospital inpatients showed interventions to be associated with improvement in prescribing according to antibiotic policy in routine clinical practice, with 70% of interventions being hospital-wide compared with 31% for RCTs.
Journal ArticleDOI
Effect of Clinical Decision-Support Systems: A Systematic Review
Tiffani J Bright,Anthony Wong,Ravi Dhurjati,Erin Bristow,Lori A. Bastian,Remy R Coeytaux,Gregory P. Samsa,Vic Hasselblad,John W Williams,Michael Musty,Liz Wing,Amy S Kendrick,Gillian D Sanders,David F. Lobach +13 more
TL;DR: Both commercially and locally developed CDSSs are effective at improving health care process measures across diverse settings, but evidence for clinical, economic, workload, and efficiency outcomes remains sparse.
Journal Article
Effect of Clinical Decision-Support Systems
Tiffani J Bright,Anthony Wong,Ravi Dhurjati,Erin Bristow,Lori A. Bastian,Remy R Coeytaux,Gregory P. Samsa,Vic Hasselblad,John W Williams,Michael Musty,Liz Wing,Amy S Kendrick,Gillian D Sanders,David F. Lobach +13 more
TL;DR: In this paper, a review summarizes trials of clinical decision support systems implemented in clinical settings to aid decision-making at the point-of-care (POC) level, and concludes that the evidence to support widespread use of CDSSs is lacking.
References
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TL;DR: Improvement in practitioner performance was associated with CDSSs that automatically prompted users compared with requiring users to activate the system and studies in which the authors were not the developers, as well as other factors.