Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit.
OBJECTIVE
To implement and evaluate the effect of a computerized decision support tool on antibiotic use in an intensive care unit (ICU).


METHODS
Prospective before-and-after cohort study.


METHODS
Twenty-four bed tertiary hospital adult medical/surgical ICU.


METHODS
All consecutive patients from May 2001 to November 2001 (N = 524) and March 2002 to September 2002 (N = 536).


METHODS
A real-time microbiology browser and computerized decision support system for isolate directed antibiotic prescription.


METHODS
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.
Thursky
Karin A
KA
Clinical Epidemiology and Health Services Evaluation Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia. karin.thursky@mh.org.au
Buising
Kirsty L
KL
Bak
Narin
N
Macgregor
Lachlan
L
Street
Alan C
AC
Macintyre
C Raina
CR
Presneill
Jeffrey J
JJ
Cade
John F
JF
Brown
Graham V
GV
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003658:Decision Making, Computer-Assisted; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014739:Victoria
D000900:Anti-Bacterial Agents