A Real-world Evaluation of a Case-based Reasoning Algorithm to Support Antimicrobial Prescribing Decisions in Acute Care.
Clin Infect Dis
; 72(12): 2103-2111, 2021 06 15.
Article
em En
| MEDLINE
| ID: mdl-32246143
ABSTRACT
BACKGROUND:
A locally developed case-based reasoning (CBR) algorithm, designed to augment antimicrobial prescribing in secondary care was evaluated.METHODS:
Prescribing recommendations made by a CBR algorithm were compared to decisions made by physicians in clinical practice. Comparisons were examined in 2 patient populations first, in patients with confirmed Escherichia coli blood stream infections ("E. coli patients"), and second in ward-based patients presenting with a range of potential infections ("ward patients"). Prescribing recommendations were compared against the Antimicrobial Spectrum Index (ASI) and the World Health Organization Essential Medicine List Access, Watch, Reserve (AWaRe) classification system. Appropriateness of a prescription was defined as the spectrum of the prescription covering the known or most-likely organism antimicrobial sensitivity profile.RESULTS:
In total, 224 patients (145 E. coli patients and 79 ward patients) were included. Mean (standard deviation) age was 66 (18) years with 108/224 (48%) female sex. The CBR recommendations were appropriate in 202/224 (90%) compared to 186/224 (83%) in practice (odds ratio [OR] 1.24 95% confidence interval [CI] .392-3.936; P = .71). CBR recommendations had a smaller ASI compared to practice with a median (range) of 6 (0-13) compared to 8 (0-12) (P < .01). CBR recommendations were more likely to be classified as Access class antimicrobials compared to physicians' prescriptions at 110/224 (49%) vs. 79/224 (35%) (OR 1.77; 95% CI 1.212-2.588; P < .01). Results were similar for E. coli and ward patients on subgroup analysis.CONCLUSIONS:
A CBR-driven decision support system provided appropriate recommendations within a narrower spectrum compared to current clinical practice. Future work must investigate the impact of this intervention on prescribing behaviors more broadly and patient outcomes.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Gestão de Antimicrobianos
/
Anti-Infecciosos
Tipo de estudo:
Guideline
/
Prognostic_studies
Limite:
Aged
/
Female
/
Humans
Idioma:
En
Revista:
Clin Infect Dis
Assunto da revista:
DOENCAS TRANSMISSIVEIS
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Reino Unido