International Journal for Quality in Health Care Advance Access published online on January 13, 2006
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzi095
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1 Victorian Infectious Diseases Service and Centre for Clinical Research Excellence in Infectious Diseases, Royal Melbourne Hospital, Melbourne, Victoria, Australia
* To whom correspondence should be addressed. 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 work-flow. 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.
Accepted November 17, 2005
Article
Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit
Karin A. Thursky 1 *,
Kirsty L. Buising 1,
Narin Bak 1,
Lachlan Macgregor 2,
Alan C. Street 1,
C. Raina Macintyre 1,
Jeffrey J. Presneill 3,
John F. Cade 3,
and
Graham V. Brown 1
2 Clinical Epidemiology and Health Services Evaluation Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
3 Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Karin A. Thursky, E-mail: karin.thursky{at}mh.org.au
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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., September 1, 2008; 62(3): 608 - 616. [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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