Category: Fellows Posters
Purpose: Clinical decision support systems (CDSS) can play an important role in facilitating antimicrobial stewardship programs (ASP). However, the effects of CDSS on improving antimicrobial therapy have been insufficiently studied.
The aim of this study is to evaluate the impact of an automated/integrated real-time CDSS called HIGEA for antimicrobial stewardship-related interventions and in the reduction of the use of quinolones.
Methods: This was a prospective descriptive study performed in a 1300-bed tertiary teaching hospital in Madrid (Spain). A CDSS was developed integrating microbiology data, laboratory data and the computerized prescription order system. The integration was performed using a standard language (HL7). The system generates alerts based on predefined clinical rules (CR) to select patients in whom antimicrobial therapy can be improved. Alerts are reviewed daily by an infectious disease pharmacist, who makes recommendations of the necessary changes on the treatment to the physician. Alerts promoting the suspension of antibiotic treatment in patients treated with ciprofloxacin or levofloxacin > 7 days from 01/07/2017 to 12/05/2017 was evaluated. Critical, hematological and pediatric patients were excluded. Data collection included total number of actionable alerts, recommendations provided and acceptance rates. For each CR, the positive predictive value (PPV) was calculated as the ratio of modifications in treatment to alerts reviewed. The clinical characteristics of the patients in whom the alert was accepted and the consumption of quinolones (Defined Daily Doses-100 patient-days) were also analyzed.
In total, 276 alerts corresponding to 276 patients were reviewed during the study period. Overall, 136 (49.3%) alerts were actionable. The acceptance rate was 78% (106/136), and the PPV 0.38.
The average age of the patients in whom quinolone treatment was discontinued was 81 years (IQR 67-90). The admission services were: Internal Medicine (24.5%), Geriatrics (24.5%), Pulmonology (13.2%) and others (37.8%). The most frequent infections were pneumonia (58.0%) and urinary infection (17.0%). 30.2% of the patients had received prior antibiotic treatment for the same infection and 48.1% received it concomitantly.
In relation to treatment with quinolones, 71.1% of the patients received levofloxacin (32.0% orally) and 29.0% ciprofloxacin (54.8% orally). Treatment was empirical in 82.1% of the patients, targeted in 11.3% and prophylactic in 5.7%. Overall, 48.1% of the patients had a requested microbiological sample at the beginning of the treatment, and 28.3% had a positive microbiological isolation during admission.
In 79.2% of the patients the clinical resolution of the infection was reached. Mortality was 13.2% (in all cases not related to the infection) and in 4.7% of the cases recurrence of the infection was observed. A significant reduction in the consumption of quinolones was achieved (from 16.4 to 14.9).
HIGEA has identified opportunities to optimize antimicrobial use and for the detection of patients in whom quinolone treatment should be suspended. The suspension of treatment was not correlated with unfavorable clinical results. This project helps reduce the consumption of quinolones in the hospital.