International Journal for Quality in Health Care Advance Access originally published online on January 13, 2006
International Journal for Quality in Health Care 2006 18(3):224-231; doi:10.1093/intqhc/mzi095
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Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit
1 Victorian Infectious Diseases Service and Centre for Clinical Research Excellence in Infectious Diseases, 2 Intensive Care Unit, and 3 Clinical Epidemiology and Health Services Evaluation Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Objective. To implement and evaluate the effect of a computerized decision support tool on antibiotic use in an intensive care unit (ICU).
Design. Prospective before-and-after cohort study.
Setting. Twenty-four bed tertiary hospital adult medical/surgical ICU.
Participants. All consecutive patients from May 2001 to November 2001 (N = 524) and March 2002 to September 2002 (N = 536).
Intervention. A real-time microbiology browser and computerized decision support system for isolate directed antibiotic prescription.
Main outcome measures. Number of courses of antibiotic prescribed, antibiotic utilization (defined daily doses (DDDs)/100 ICU bed-days), antibiotic susceptibility mismatches, and system uptake.
Results. There was a significant reduction in the proportion of patients prescribed carbapenems [odds ratio (OR) = 0.61, 95% confidence interval (CI) = 0.39–0.97, P = 0.04], third-generation cephalosporins (OR = 0.58, 95% CI = 0.42–0.79, P = 0.001), and vancomycin (OR = 0.67, 95% CI = 0.45–1.00, P = 0.05) after adjustment for risk factors including Apache II score, suspected infection, positive microbiology, intubation, and length of stay. The decision support tool was associated with a 10.5% reduction in both total antibiotic utilization (166–149 DDDs/100 ICU bed days) and the highest volume broad-spectrum antibiotics. There were fewer susceptibility mismatches for initial antibiotic therapy (OR = 0.63, 95% CI = 0.39–0.98, P = 0.02) and increased de-escalation to narrower spectrum antibiotics. Uptake of the program was high with 6028 access episodes during the 6-month evaluation period.
Conclusions. This tool streamlined collation and clinical use of microbiology results and integrated into the daily ICU workflow. Its introduction was accompanied by a reduction in both total and broad-spectrum antibiotic use and an increase in the number of switches to narrower spectrum antibiotics.
Keywords: antibiotic use, computerized decision support, intensive care
Address reprint requests to Karin A. Thursky, Victorian Infectious Diseases Service, 9th Floor, Royal Melbourne Hospital, Grattan St, Parkville, Victoria 3050, Australia. E-mail: karin.thursky{at}mh.org.au
Accepted for publication November 17, 2005.
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  K. L. Buising, K. A. Thursky, M. B. Robertson, J. F. Black, A. C. Street, M. J. Richards, and G. V. Brown Electronic antibiotic stewardship--reduced consumption of broad-spectrum antibiotics using a computerized antimicrobial approval system in a hospital setting J. Antimicrob. Chemother., June 11, 2008; (2008) dkn218v1. [Abstract] [Full Text] [PDF]
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 S. C. Arya, N. Agarwal, and S. Agarwal Re: Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit Int. J. Qual. Health Care, October 1, 2006; 18(5): 389 - 389. [Full Text] [PDF]
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