title: Evaluation of the decision support system for antimicrobial treatment, TREAT, in an acute medical ward of a university hospital.
abstract: OBJECTIVE
  TREAT, a decision support system for antimicrobial therapy, was implemented in an acute medical ward.
  
  
  METHODS
  Patients admitted on suspicion of infection were included in the study. The evaluation of TREAT was done both retrospectively and prospectively. Coverage of empirical antimicrobial treatments was compared to recommendations from TREAT and the optimal use of local guidelines.
  
  
  RESULTS
  Five hundred and eleven patients were included, of whom 162 had a microbiologically documented infection. In the retrospective part of the study, TREAT, physician, and guideline antimicrobial coverage rates were 65%, 51%, and 79%, respectively, and in the prospective part, 68%, 62%, and 77%, respectively. TREAT provided lower coverage than local guidelines (p<0.001), but was similar to the performance of physicians in a university hospital (p=0.069). No differences were found in length of hospital stay, or hospital or 30-day mortality. Direct costs were significantly higher for TREAT advice than for local guidelines or the physician prescriptions (p<0.001), but the ecological costs were lower for TREAT advice than for both local guidelines (p<0.001) and physician prescriptions (p=0.247). The coverage of TREAT advice for the bacteraemia patients was non-inferior to the physicians (p=1.00).
  
  
  CONCLUSIONS
  TREAT can potentially improve the ecological costs of empirical antimicrobial therapy for patients in acute medical wards, but provided lower coverage than local guidelines.
authors.affiliation: Department of Internal Medicine, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark. Electronic address: bentearboe@hotmail.com.
authors.forename: Bente
authors.initials: B
authors.lastname: Arboe
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark.
authors.forename: Rasmus Rude
authors.initials: RR
authors.lastname: Laub
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark.
authors.forename: Gitte
authors.initials: G
authors.lastname: Kronborg
authors.affiliation: Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark.
authors.forename: Jenny Dahl
authors.initials: JD
authors.lastname: Knudsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy; D001424:Bacterial Infections / Q000188:drug therapy*; D015331:Cohort Studies; D020000:Decision Support Systems, Clinical; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute medicine; Antimicrobial treatment; Decision support system; Infection; TREAT