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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Veröffentlicht in:	International journal of infectious diseases Jg. 29; H. C; S. 156 - 161
Hauptverfasser:	Arboe, Bente, Laub, Rasmus Rude, Kronborg, Gitte, Knudsen, Jenny Dahl
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Canada Elsevier Ltd 01.12.2014 Elsevier
Schlagworte:	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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Abstract	•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.
AbstractList	Objectives: TREAT, a decision support system for antimicrobial therapy, was implemented in an acute medical ward. Methods: 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. Results: 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). Conclusions: TREAT can potentially improve the ecological costs of empirical antimicrobial therapy for patients in acute medical wards, but provided lower coverage than local guidelines. 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. •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. Highlights • 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.OBJECTIVESTREAT, 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.METHODSPatients 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).RESULTSFive 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.CONCLUSIONSTREAT can potentially improve the ecological costs of empirical antimicrobial therapy for patients in acute medical wards, but provided lower coverage than local guidelines.
Author	Arboe, Bente Kronborg, Gitte Laub, Rasmus Rude Knudsen, Jenny Dahl
Author_xml	– sequence: 1 givenname: Bente surname: Arboe fullname: Arboe, Bente email: bentearboe@hotmail.com organization: Department of Internal Medicine, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark – sequence: 2 givenname: Rasmus Rude surname: Laub fullname: Laub, Rasmus Rude organization: Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark – sequence: 3 givenname: Gitte surname: Kronborg fullname: Kronborg, Gitte organization: Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark – sequence: 4 givenname: Jenny Dahl surname: Knudsen fullname: Knudsen, Jenny Dahl organization: Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/25461242$$D View this record in MEDLINE/PubMed
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CitedBy_id	crossref_primary_10_1016_j_ifacol_2018_11_657 crossref_primary_10_1111_ijpp_12274 crossref_primary_10_1007_s11908_019_0683_8 crossref_primary_10_1016_j_artmed_2020_101895 crossref_primary_10_1016_j_ajic_2020_02_006 crossref_primary_10_1016_j_ijmedinf_2016_04_008 crossref_primary_10_1136_bmjopen_2022_065845 crossref_primary_10_1185_03007995_2016_1154520 crossref_primary_10_1371_journal_pone_0183062 crossref_primary_10_1080_00207721_2017_1365968 crossref_primary_10_1186_s12879_021_06547_0 crossref_primary_10_1016_j_ijantimicag_2023_106787
Cites_doi	10.1093/jac/dkn504 10.1093/jac/dki037 10.1197/jamia.M2384 10.1111/j.1445-5994.2006.01002.x 10.1001/archinternmed.2009.265 10.1007/s10096-011-1478-5 10.1001/archinternmed.2009.259 10.1093/intqhc/mzq077 10.1086/503034 10.1093/jac/dki279 10.1016/j.ijantimicag.2007.06.035 10.1093/jac/dkm107 10.1093/jac/dkl372
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Keywords	Infection Antimicrobial treatment Acute medicine Decision support system TREAT
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Snippet	•We evaluate TREAT, a decision support system on antimicrobial therapy.•TREAT provided lower coverage than the local guidelines.•TREAT was implemented in an... Highlights • We evaluate TREAT, a decision support system on antimicrobial therapy. • TREAT provided lower coverage than the local guidelines. • TREAT was... TREAT, a decision support system for antimicrobial therapy, was implemented in an acute medical ward. Patients admitted on suspicion of infection were included... TREAT, a decision support system for antimicrobial therapy, was implemented in an acute medical ward.OBJECTIVESTREAT, a decision support system for... Objectives: TREAT, a decision support system for antimicrobial therapy, was implemented in an acute medical ward. Methods: Patients admitted on suspicion of...
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SubjectTerms	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
Title	Evaluation of the decision support system for antimicrobial treatment, TREAT, in an acute medical ward of a university hospital
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