Sustained reduction in antimicrobial use and decrease in methicillin-resistant Staphylococcus aureus and Clostridium difficile infections following implementation of an electronic medical record at a tertiary-care teaching hospital.
OBJECTIVE
we evaluated the effect of implementation of an electronic medical record (EMR) on the use of antimicrobial agents and on the rates of infections with Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA).


METHODS
this was a retrospective, observational study conducted between 1 January 2005 and 31 December 2009. Antimicrobial drug use, rates of nosocomial C. difficile infection (CDI) and MRSA infection, the number of medical charts reviewed and number of antimicrobial recommendations made and accepted were compared before and after implementing the EMR utilizing interrupted time-series analysis.


RESULTS
compared with the 10 quarters prior to implementing the EMR, there was a 36.6% increase in the number of charts reviewed (P < 0.0001), a 98.1% increase in the number of antimicrobial recommendations made (P < 0.0001) and a 124% increase in the number of recommendations accepted (P < 0.0001). There was a 28.8% decrease in the use of 41 commonly used antibacterial agents (P < 0.0001). Nosocomial CDI decreased by 18.7% (P = 0.07) and nosocomial MRSA infections decreased by 45.2% (P < 0.0001) following implementation of the EMR.


CONCLUSIONS
adoption of an EMR facilitated a significant increase in chart reviews and antimicrobial recommendations, which resulted in a sustained decrease in antimicrobial use. There were decreased nosocomial infections with MRSA and a trend towards decreasing CDIs following implementation of the EMR.
Division of Infectious Diseases, Department of Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA. cookp@ecu.edu
Paul P
PP
Cook
Shemra
S
Rizzo
Michael
M
Gooch
Michelle
M
Jordan
Xiangming
X
Fang
Suzanne
S
Hudson
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D006784:Hospitals, Teaching; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D015995:Prevalence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology
D000900:Anti-Bacterial Agents