title: Impact of a computerized decision support system on compliance with guidelines on antibiotics prescribed for urinary tract infections in emergency departments: a multicentre prospective before-and-after controlled interventional study.
abstract: OBJECTIVE
  Urinary tract infections (UTIs) are one of the leading reasons for antibiotic prescriptions in emergency departments (EDs), with half of these antibiotics being inappropriately prescribed. Our objective was to assess the impact of a computerized decision support system (CDSS) on compliance with guidelines on empirical antibiotic prescriptions (antibiotic and duration) for UTIs in EDs.
  
  
  METHODS
  A multicentre prospective before-and-after controlled interventional study was conducted from 19 March to 28 October 2012. All adults diagnosed with community-acquired UTIs (cystitis, pyelonephritis or prostatitis) at three French EDs were included. The antibiotic therapy was considered compliant with guidelines if the antibiotic and the duration prescribed were in accordance with the national guidelines. Data were collected using electronic medical records. Paired tests were used when comparing periods within each ED and global analyses used multivariate logistic mixed models.
  
  
  RESULTS
  Nine hundred and twelve patients were included during the 30 week study period. The CDSS was used in 59% of cases (182/307). The CDSS intervention improved the compliance of antibiotic prescriptions in only one ED in a bivariate analysis (absolute increase +20%, P = 0.007). The choice of the antibiotic was improved in multivariate analyses but only when the CDSS was used [OR = 1.94 (95% CI 1.13-3.32)]. The CDSS also changed the initial diagnosis in 23% of cases, in all three EDs.
  
  
  CONCLUSIONS
  The CDSS only partially improved compliance with guidelines on antibiotic prescriptions in UTIs.
authors.affiliation: Faculté de Médecine, Université Nice-Sophia Antipolis, Nice, France Service d'Infectiologie, CHU de Nice, Nice, France.
authors.forename: Elisa
authors.initials: E
authors.lastname: Demonchy
authors.affiliation: BIOSTIC, Pôle de Santé Publique, Assistance Publique-Hôpitaux de Marseille, Marseille, France UMR912 SESSTIM (AMU-INSERM-IRD-AMSE), Aix-Marseille University, Marseille, France.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Dufour
authors.affiliation: BIOSTIC, Pôle de Santé Publique, Assistance Publique-Hôpitaux de Marseille, Marseille, France UMR912 SESSTIM (AMU-INSERM-IRD-AMSE), Aix-Marseille University, Marseille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Gaudart
authors.affiliation: ORU PACA, Observatoire Régional des Urgences en région Provence-Alpes-Côte d'Azur, Hyères, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cervetti
authors.affiliation: Service d'Accueil des Urgences, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Michelet
authors.affiliation: Service d'Accueil des Urgences, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Poussard
authors.affiliation: Faculté de Médecine, Université Nice-Sophia Antipolis, Nice, France Service d'Accueil des Urgences, CHU de Nice, Nice, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Levraut
authors.affiliation: Faculté de Médecine, Université Nice-Sophia Antipolis, Nice, France Service d'Infectiologie, CHU de Nice, Nice, France UMR912 SESSTIM (AMU-INSERM-IRD-AMSE), Aix-Marseille University, Marseille, France pulcini.c@chu-nice.fr.
authors.forename: Céline
authors.initials: C
authors.lastname: Pulcini
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003198:Computer Simulation; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008490:Medical Informatics / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic stewardship; emergency medicine; hospital; quality