Evaluation of the decision support system for antimicrobial treatment, TREAT, in an acute medical ward of a university hospital

•We evaluate TREAT, a decision support system on antimicrobial therapy.•TREAT provided lower coverage than the local guidelines.•TREAT was implemented in an acute medical ward and compared to empirical treatment.•TREAT provided insignificantly higher coverage than the physicians.•TREAT provided guid...

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Vydáno v:International journal of infectious diseases Ročník 29; číslo C; s. 156 - 161
Hlavní autoři: Arboe, Bente, Laub, Rasmus Rude, Kronborg, Gitte, Knudsen, Jenny Dahl
Médium: Journal Article
Jazyk:angličtina
Vydáno: Canada Elsevier Ltd 01.12.2014
Elsevier
Témata:
Acute medicine
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Antimicrobial treatment
Bacteremia - drug therapy
Bacterial Infections - drug therapy
Cohort Studies
Decision support system
Decision Support Systems, Clinical
Female
Hospitals, University
Humans
Infection
Infectious Disease
Length of Stay
Male
Middle Aged
Prospective Studies
Pulmonary/Respiratory
Retrospective Studies
TREAT
Treatment Outcome
Young Adult
Infection
Antimicrobial treatment
Acute medicine
Decision support system
TREAT
ISSN:1201-9712, 1878-3511, 1878-3511
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Shrnutí:•We evaluate TREAT, a decision support system on antimicrobial therapy.•TREAT provided lower coverage than the local guidelines.•TREAT was implemented in an acute medical ward and compared to empirical treatment.•TREAT provided insignificantly higher coverage than the physicians.•TREAT provided guidance with lower ecological and direct costs. TREAT, a decision support system for antimicrobial therapy, was implemented in an acute medical ward. Patients admitted on suspicion of infection were included in the study. The evaluation of TREAT was done both retrospectively and prospectively. Coverage of empirical antimicrobial treatments was compared to recommendations from TREAT and the optimal use of local guidelines. Five hundred and eleven patients were included, of whom 162 had a microbiologically documented infection. In the retrospective part of the study, TREAT, physician, and guideline antimicrobial coverage rates were 65%, 51%, and 79%, respectively, and in the prospective part, 68%, 62%, and 77%, respectively. TREAT provided lower coverage than local guidelines (p<0.001), but was similar to the performance of physicians in a university hospital (p=0.069). No differences were found in length of hospital stay, or hospital or 30-day mortality. Direct costs were significantly higher for TREAT advice than for local guidelines or the physician prescriptions (p<0.001), but the ecological costs were lower for TREAT advice than for both local guidelines (p<0.001) and physician prescriptions (p=0.247). The coverage of TREAT advice for the bacteraemia patients was non-inferior to the physicians (p=1.00). TREAT can potentially improve the ecological costs of empirical antimicrobial therapy for patients in acute medical wards, but provided lower coverage than local guidelines.
Bibliografie:ObjectType-Article-2
SourceType-Scholarly Journals-1
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ISSN:1201-9712
1878-3511
1878-3511
DOI:10.1016/j.ijid.2014.08.019