Impact of an electronic alert on prescription patterns of meropenem, voriconazole and caspofungin

Lionel Chok,Claudine Kocher,Rainer Weber,Stefan P Kuster,Katharina Kusejko,Nadia Eberhard,Roger D Kouyos,Dirk Saleschus,Sandra E Chaudron

doi:10.1186/s12879-021-06980-1

Lionel Chok, Claudine Kocher + Show 7 more

Open Access

https://doi.org/10.1186/s12879-021-06980-1

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Abstract

BackgroundAntimicrobial stewardship programs promote the appropriate use of antimicrobial substances through the implementation of evidence-based, active and passive interventions. We analyzed the effect of a computer-assisted intervention on antimicrobial use in a tertiary care hospital.MethodsBetween 2011 and 2016 we introduced an electronic alert for patients being prescribed meropenem, voriconazole and caspofungin. At prescription and at day 3 of treatment, physicians were informed about the risk related to these antimicrobial substances by an electronic alert in the medical records. Physicians were invited to revoke or confirm the prescription and to contact the infectious disease (ID) team. Using interrupted time series regression, the days of therapy (DOTs) and the number of prescriptions before and after the intervention were compared.ResultsWe counted 64,281 DOTs for 5549 prescriptions during 4100 hospital stays. Overall, the DOTs decreased continuously over time. An additional benefit of the alert could not be observed. Similarly, the number of prescriptions decreased over time, without significant effect of the intervention. When considering the three drugs separately, the alert impacted the duration (change in slope of DOTs/1000 bed days; P = 0.0017) as well as the number of prescriptions (change in slope of prescriptions/1000 bed days; P < 0.001) of voriconazole only.ConclusionsThe introduction of the alert lowered prescriptions of voriconazole only. Thus, self-stewardship alone seems to have a limited impact on electronic prescriptions of anti-infective substances. Additional measures such as face-to-face prompting with ID physicians or audit and feedback are indispensable to optimize antimicrobial use.

Highlights

Antimicrobial stewardship programs promote the appropriate use of antimicrobial substances through the implementation of evidence-based, active and passive interventions
The length of stay (LOS) was longest with 35 days for patients who were prescribed caspofungin (IQR 19–57), followed by meropenem with 24 days (IQR 14–40) and voriconazole with 24 days (IQR 9–36)
Meropenem accounted for 60.9% of all Days of therapy (DOTs) (39,156 DOTs, 3695 prescriptions), followed by voriconazole with 19.7% of all DOTs (12,640 DOTs, 1055 prescriptions) and caspofungin with 19.4% of all DOTs (12,485 DOTs, 799 prescriptions)

Summary

Introduction

Antimicrobial stewardship programs promote the appropriate use of antimicrobial substances through the implementation of evidence-based, active and passive interventions. Individual disease-based support for antimicrobial decision making by an infectious disease (ID) specialist or a pharmacist with antimicrobial stewardship training is timeconsuming and costly. Computer-based surveillance and clinical decision support systems have been shown to improve the use of antimicrobials and may be part of ASPs [9]. Algorithms providing assistance on antibiotic decision-making may allow a broad and cost-saving implementation of ASP interventions. The Guidelines of the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) on ASPs support interventions encouraging routine review of the appropriateness of antibiotic therapy by the prescriber itself [8]

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