Abstract
Antibiotic computerised decision support systems (CDSSs) are shown to improve antibiotic prescribing, but evidence of beneficial patient outcomes is limited. We conducted a prospective cohort study in a 1500-bed tertiary-care hospital in Singapore, to evaluate the effectiveness of the hospital’s antibiotic CDSS on patients’ clinical outcomes, and the modification of these effects by patient factors. To account for clustering, we used multilevel logistic regression models. One-quarter of 1886 eligible inpatients received CDSS-recommended antibiotics. Receipt of antibiotics according to CDSS’s recommendations seemed to halve mortality risk of patients (OR 0.54, 95% CI 0.26–1.10, P = 0.09). Patients aged ≤65 years had greater mortality benefit (OR 0.45, 95% CI 0.20–1.00, P = 0.05) than patients that were older than 65 (OR 1.28, 95% CI 0.91–1.82, P = 0.16). No effect was observed on incidence of Clostridium difficile (OR 1.02, 95% CI 0.34–3.01), and multidrug-resistant organism (OR 1.06, 95% CI 0.42–2.71) infections. No increase in infection-related readmission (OR 1.16, 95% CI 0.48–2.79) was found in survivors. Receipt of CDSS-recommended antibiotics reduced mortality risk in patients aged 65 years or younger and did not increase the risk in older patients. Physicians should be informed of the benefits to increase their acceptance of CDSS recommendations.
Highlights
Antibiotics are among the major developments in modern medicine, saving countless lives over the decades[1]
Our study suggests that age (< = 65 years) modified the effect of receipt of antibiotics according to ARUSC’s recommendations in reducing mortality risk; as such, the combined effect of age and receipt of antibiotics according to ARUSC’s recommendations was larger than the combination of their component effects (Fig. 1)
We found that the receipt of antibiotics according to the computerised decision support systems (CDSSs)’s recommendations reduced the risk for 30-day all-cause mortality in patients aged 65 years and below, and did not increase the risk in older patients > 65 years old
Summary
Antibiotics are among the major developments in modern medicine, saving countless lives over the decades[1]. Antibiotic use in hospitals has increased substantially[2,3]. Hospital antimicrobial stewardship programmes have been established to facilitate the optimal use of antibiotics[2,4,9,10,11]. Antimicrobial stewardship can improve antibiotic prescribing and clinical outcomes in hospital inpatients[2]. Understanding the clinical benefits of CDSSs is essential to increase physicians’ confidence in and acceptance of recommendations by antibiotic CDSSs. We conducted a prospective cohort study to evaluate the effectiveness of a tertiary hospital’s in-house antibiotic CDSS, “Antimicrobial Resistance Utilization and Surveillance Control” (ARUSC), on mortality, readmission, incidence of Clostridium difficile infection (CDI), and multidrug resistant organism (MDRO) infection, and the modification of these effects by patient factors
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