title: Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit.
abstract: 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.
authors.affiliation: Clinical Epidemiology and Health Services Evaluation Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia. karin.thursky@mh.org.au
authors.forename: Karin A
authors.initials: KA
authors.lastname: Thursky
authors.forename: Kirsty L
authors.initials: KL
authors.lastname: Buising
authors.forename: Narin
authors.initials: N
authors.lastname: Bak
authors.forename: Lachlan
authors.initials: L
authors.lastname: Macgregor
authors.forename: Alan C
authors.initials: AC
authors.lastname: Street
authors.forename: C Raina
authors.initials: CR
authors.lastname: Macintyre
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Presneill
authors.forename: John F
authors.initials: JF
authors.lastname: Cade
authors.forename: Graham V
authors.initials: GV
authors.lastname: Brown
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents