Outcomes of multisite antimicrobial stewardship programme implementation with a shared clinical decision support system.
Studies evaluating antimicrobial stewardship programmes (ASPs) supported by computerized clinical decision support systems (CDSSs) have predominantly been conducted in single site metropolitan hospitals.



To examine outcomes of multisite ASP implementation supported by a centrally deployed CDSS.



An interrupted time series study was conducted across five hospitals in New South Wales, Australia, from 2010 to 2014. Outcomes analysed were: effect of the intervention on targeted antimicrobial use, antimicrobial costs and healthcare-associated Clostridium difficile infection (HCA-CDI) rates. Infection-related length of stay (LOS) and standardized mortality ratios (SMRs) were also assessed.



Post-intervention, antimicrobials targeted for increased use rose from 223 to 293 defined daily doses (DDDs)/1000 occupied bed days (OBDs)/month (+32%, P  <   0.01). Conversely, antimicrobials targeted for decreased use fell from 254 to 196 DDDs/1000 OBDs/month (-23%; P  <   0.01). These effects diminished over time. Antimicrobial costs decreased initially (-AUD$64551/month; P  <   0.01), then increased (+AUD$7273/month; P  <   0.01). HCA-CDI rates decreased post-intervention (-0.2 cases/10 000 OBDs/month; P  <   0.01). Proportional LOS reductions for key infections (respiratory from 4.8 to 4.3 days, P  <   0.01; septicaemia 6.8 to 6.1 days, P  <   0.01) were similar to background LOS reductions (2.1 to 1.9 days). Similarly, infection-related SMRs (observed/expected deaths) decreased (respiratory from 1.1 to 0.75; septicaemia 1.25 to 0.8; background rate 1.19 to 0.90.



Implementation of a collaborative multisite ASP supported by a centrally deployed CDSS was associated with changes in targeted antimicrobial use, decreased antimicrobial costs, decreased HCA-CDI rates, and no observable increase in LOS or mortality. Ongoing targeted interventions are suggested to promote sustainability.
Stuart E
SE
Bond
Department of Pharmacy, Prince of Wales Hospital, South Eastern Sydney Local Health District, Randwick, New South Wales, Australia.
Adriana J
AJ
Chubaty
Department of Pharmacy, St George Hospital, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia.|St George Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Suman
S
Adhikari
School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.|Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.|Department of Infectious Diseases, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.
Spiros
S
Miyakis
Department of Infectious Diseases, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.
Craig S
CS
Boutlis
School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.|Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.|Division of Medicine, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.
Wilfred W
WW
Yeo
School of Mathematics and Applied Statistics, University of Wollongong, New South Wales, Australia.
Marijka J
MJ
Batterham
Performance Unit, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia.
Cara
C
Dickson
Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia.
Brendan J
BJ
McMullan
Department of Pharmacy, Sydney Children's Hospital, Randwick, New South Wales, Australia.
Mona
M
Mostaghim
Information Management Services Directorate, South Eastern Sydney Local Health District, Randwick, New South Wales, Australia.
Samantha
S
Li-Yan Hui
Department of Infectious Diseases, Prince of Wales Hospital, South Eastern Sydney Local Health District, Randwick, New South Wales, Australia.
Kate R
KR
Clezy
St George Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.|Department of Infectious Diseases, Immunology & Sexual Health, St George Hospital, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia.
Pamela
P
Konecny
D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use; D000073602:Antimicrobial Stewardship / Q000331:legislation & jurisprudence; D001315:Australia; D003428:Cross Infection / Q000188:drug therapy / Q000401:mortality; D020000:Decision Support Systems, Clinical; D006284:Health Plan Implementation; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D065186:Interrupted Time Series Analysis / Q000706:statistics & numerical data / Q000600:supply & distribution; D007902:Length of Stay
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents