A novel approach to antimicrobial stewardship programme: smart computerized decision support system
Abstract number: R2195
Objectives: Our 1200-bed hospital has high rates of MRSA, ESBL Escherichia coli and Klebsiella, and multidrug-resistant Acinetobacter, with very high ceftriaxone and fluoroquinolone usage, and rising carbapenem and piperacillintazobactam usage. Daily antibiotic orders averaged 218 over 9 weeks, making manual review and feedback laborious.
Methods: Our hospital has comprehensive information technology (IT) systems including electronic inpatient medication record (eIMR). We designed ARUS_C integrated in doctors' work process to guide them in antibiotic use by adopting evidence-based medicine and real-time IT data.
Results: Doctors launch ARUS_C from eIMR to select empiric, definitive or prophylactic antibiotic, and infectious disease (ID) condition to treat. By entering data unavailable in IT systems, doctors can view antibiotic recommendation including renal dose adjustment, duration of therapy, allergy, antibiotic toxicity and monitoring, therapeutic duplication, and antibiotic and microbiological data summary. ARUS_C checks for healthcare-associated infection, prior antibiotic-resistant bacteria, and illness severity influencing antibiotic selection. It provides clues to diagnosis, investigation and referral for selected ID condition, and interpretation of positive microbiological cultures. From empiric to definitive antibiotic use, ARUS_C provides guidance to treat culture-positive infections using narrow-spectrum culture-guided antibiotic, step-down therapy in culture-negative infections with improvement, and recommend referral and further investigation in non-improving culture-negative infections. It advises antibiotic for multiple bacteria, including route and duration, based on ID condition, culture site and clinical response. Doctors are able to over-ride ARUS_C. Usage of ARUS_C rose from 76 episodes in week one to 216295 from weeks 49, with over-rides ranging from 840 per week. Daily usage ranges from 3036 for week days, and 2425 for weekends. Screen shots of ARUS_C in action, and data on efficacy and safety will be presented.
Conclusions: Voluntary ARUS_C use was hampered by IT errors, and doctors' mindset. Mandatory ARUS_C use may be needed to achieve significant reduction in overall and broad-spectrum antibiotic use. Further evaluation of ARUS_C is under way.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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