title: Performance of the TREAT decision support system in an environment with a low prevalence of resistant pathogens.
abstract: OBJECTIVE
  To evaluate a decision support system (TREAT) for guidance of empirical antimicrobial therapy in an environment with a low prevalence of resistant pathogens.
  
  
  METHODS
  A retrospective trial of TREAT has been performed at Copenhagen University, Hvidovre Hospital. The cohort of patients included adults with systemic inflammation and suspicion of community-acquired bacterial infection. The empirical antimicrobial treatment recommended by TREAT was compared with the empirical antimicrobial treatment prescribed by the first attending clinical physician.
  
  
  RESULTS
  Out of 171 patients recruited, 161 (65 with microbiologically documented infections) fulfilled the inclusion criteria of TREAT. Coverage achieved by TREAT was significantly higher than that by clinical practice (86% versus 66%, P = 0.007). There was no significant difference in the cost of future resistance between treatments chosen by TREAT and those by physicians. The direct expenses for antimicrobials were higher in TREAT when including patients without antimicrobial treatment, while there was no significant difference otherwise. The cost of side effects was significantly lower using TREAT.
  
  
  CONCLUSIONS
  The results of the study suggest that TREAT can improve the appropriateness of antimicrobial therapy and reduce the cost of side effects in regions with a low prevalence of resistant pathogens, however, at the expense of increased use of antibiotics.
authors.affiliation: Clinical Research Centre and Department of Infectious Diseases, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Kofoed
authors.forename: Alina
authors.initials: A
authors.lastname: Zalounina
authors.forename: Ove
authors.initials: O
authors.lastname: Andersen
authors.forename: Gorm
authors.initials: G
authors.lastname: Lisby
authors.forename: Mical
authors.initials: M
authors.lastname: Paul
authors.forename: Leonard
authors.initials: L
authors.lastname: Leibovici
authors.forename: Steen
authors.initials: S
authors.lastname: Andreassen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy; D001419:Bacteria / Q000187:drug effects*; D001424:Bacterial Infections / Q000188:drug therapy*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D003718:Denmark; D024881:Drug Resistance, Bacterial; D005260:Female; D006302:Health Services Research; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents