Harnessing the wisdom of crowds can improve guideline compliance of antibiotic prescribers and support antimicrobial stewardship

Eva M Krockow,S M Herzog,J E Kämmer,N Thilly,R A Hamilton,C Pulcini,G Macheda,R H J M Kurvers

doi:10.1038/s41598-020-75063-z

Abstract

Antibiotic overprescribing is a global challenge contributing to rising levels of antibiotic resistance and mortality. We test a novel approach to antibiotic stewardship. Capitalising on the concept of “wisdom of crowds”, which states that a group’s collective judgement often outperforms the average individual, we test whether pooling treatment durations recommended by different prescribers can improve antibiotic prescribing. Using international survey data from 787 expert antibiotic prescribers, we run computer simulations to test the performance of the wisdom of crowds by comparing three data aggregation rules across different clinical cases and group sizes. We also identify patterns of prescribing bias in recommendations about antibiotic treatment durations to quantify current levels of overprescribing. Our results suggest that pooling the treatment recommendations (using the median) could improve guideline compliance in groups of three or more prescribers. Implications for antibiotic stewardship and the general improvement of medical decision making are discussed. Clinical applicability is likely to be greatest in the context of hospital ward rounds and larger, multidisciplinary team meetings, where complex patient cases are discussed and existing guidelines provide limited guidance.

Highlights

Antibiotic overprescribing is a global challenge contributing to rising levels of antibiotic resistance and mortality
Current evidence suggests that around 30–40% of antibiotic prescriptions for hospital p atients[4,5] and up to 60% of antibiotic prescriptions in primary c are[6] are inappropriate, it has to be acknowledged that inappropriate prescribing is often context-dependent and measuring it presents a challenge[7]
We provide the first application of wisdom of crowds” (WoC) theory to the problem of antibiotic decision making

Summary

Introduction

Antibiotic overprescribing is a global challenge contributing to rising levels of antibiotic resistance and mortality. In the clinical context, the interests of individual patients often loom larger than the long-term interests of society, which typically include protecting antibiotic drug effectiveness for many generations. Given these strategic properties, antibiotic prescribing has been conceptualised as a challenging social d ilemma[12,13], which may require special decision mechanisms to protect the collective interests and preserve antibiotic effectiveness. Most previous interventions to curb overprescribing of antibiotics, including unnecessarily long treatment durations, focused on improving the education and training of prescribers or regulating access to antimicrobials. One approach includes collecting individual judgements of members belonging to a larger group of decision makers and aggregating these judgements to derive a final, group-based choice

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Discussion

Conclusion