Long-term effect of computer-assisted decision support for antibiotic treatment in critically ill patients: a prospective ‘before/after’ cohort study

This is a review of Nachtigall, Tafelski, Deja, Halle, Grebe, Tamarkin and Spies 2014 article, Long-term effect of computer-assisted decision support for antibiotic treatment in critically ill patients: a prospective ‘before/after’ cohort study.

Introduction

Antibiotic resistance has become a major health concern all over the world. Much of the problem can be traced back to misuse and wrong administration of antibiotics.

When antibiotics don’t work, the result can be:

• Longer illnesses
• More complicated illnesses
• More doctor visits
• The use of stronger and more expensive drugs
• More deaths caused by bacterial infections

The authors in this article performed a prospective cohort study to determine whether a Computer-assisted Decision Support System (CDSS) can have positive adherence in an ICU surgical setting. The team hypothesized that implementation of the CDSS for antibiotic therapy should decrease antibiotic use over time and improve clinical outcome.

Methods

This prospective cohort study was conducted as a clinical prospective pre-intervention/post-intervention study over four evaluation time periods within 5 years totaling 12,965 patient days in the ICU.

During the pre-intervention period, every ward physician was given paper-based guidelines for antibiotic therapy. In contrast, during the post-intervention period, the CDSS for antibiotic therapy was implemented as a tool on every hospital computer. For every infection included in the CDSS, there is one main five-step algorithm.

Results

A total of 1,395 patients were treated during the study period. After exclusion criterion was included, 1,316 patients were included in present analysis. It is interesting to note that the study results include two significant endpoints.

In terms of the primary endpoint, adherence to guidelines increased from 61% prior to implementation to 92% in (Post 1). This percentage then decreased in (Post 2) to 76% and decrease once again to in (Post 3) with 71%. The final percentages still remained significantly higher compared with baseline values.

When the second endpoint is examined, the authors found that antibiotic-free days (AFD) increased over time. They started at 30% in all ICU days during the pre-intervention and increased to 32% (Post 1), 46% (Post 2) and finally 42% (Post 3).