Abstract
Background Antimicrobial resistance is correlated with the inappropriate use of antibiotics. Computerised decision support systems may help practitioners to make evidence-based decisions when prescribing antibiotics. Objective This study aimed to evaluate the impact of computerized decision support systems on the volume of antibiotics used. Setting A very large 1200-bed teaching hospital in Birmingham, England. Main outcome measure The primary outcome measure was the defined daily doses/1000 occupied bed-days. Method A retrospective longitudinal study was conducted to examine the impact of computerised decision support systems on the volume of antibiotic use. The study compared two periods: one with computerised decision support systems, which lasted for 2 years versus one without which lasted for 2 years after the withdrawal of computerised decision support systems. Antibiotic use data from June 2012 to June 2016 were analysed (comprising 2 years with computerised decision support systems immediately followed by 2 years where computerised decision support systems had been withdrawn). Regression analysis was applied to assess the change in antibiotic consumption through the period of the study. Result From June 2012 to June 2016, total antibiotic usage increased by 13.1% from 1436 to 1625 defined daily doses/1000 bed-days: this trend of increased antibiotic prescribing was more pronounced following the withdrawal of structured prescribing (computerised decision support systems). There was a difference of means of − 110.14 defined daily doses/1000 bed days of the total usage of antibiotics in the period with and without structured prescribing, and this was statistically significant (p = 0.026). From June 2012 to June 2016, the dominant antibiotic class used was penicillins. The trends for the total consumption of all antibiotics demonstrated an increase of use for all antibiotic classes except for tetracyclines, quinolones, and anti-mycobacterial drugs, whereas aminoglycoside usage remained stable. Conclusion The implementation of computerised decision support systems appears to influence the use of antibiotics by reducing their consumption. Further research is required to determine the specific features of computerised decision support systems, which influence increased higher adoption and uptake of this technology.
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References
Abubakar I, Dara M, Manissero D, Zumla A. Tackling the spread of drug-resistant tuberculosis in Europe. Lancet. 2012;379(9813):e21–3.
Avorn J, Barrett JF, Davey PG, McEwen S, O’Brien TF, Levy SB. Antibiotic resistance: synthesis of recommendations by expert policy groups. Geneva: World Health Organization; 2001.
Zucca M, Savoia D. The post-antibiotic era: promising developments in the therapy of infectious diseases. Int J Biomed Sci IJBS. 2010;6(2):77.
Andersson DI, Hughes D. Selection and transmission of antibiotic-resistant bacteria. Microbiol Spectr. 2017;5(4):117–37.
Control CfD Prevention. CDC’s campaign to prevent antimicrobial resistance in health-care settings. MMWR Morbidity and mortality weekly report. 2002; 51(15):343.
Cooke J, Alexander K, Charani E, Hand K, Hills T, Howard P, et al. Antimicrobial stewardship: an evidence-based, antimicrobial self-assessment toolkit (ASAT) for acute hospitals. J Antimicrob Chemother. 2010;65(12):2669–73.
Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51–77.
De Kraker M, Abbas M, Huttner B, Harbarth S. Good epidemiological practice: a narrative review of appropriate scientific methods to evaluate the impact of antimicrobial stewardship interventions. Clin Microbiol Infect. 2017;23(11):819–25.
Cresswell K, Mozaffar H, Shah S, Sheikh A. Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review. Int J Pharm Pract. 2017;25(1):5–17.
Cooke J, Stephens P, Ashiru-Oredope D, Johnson A, Livermore D, Sharland M. Antibacterial usage in English NHS hospitals as part of a national Antimicrobial Stewardship Programme. Public Health. 2014;128(8):693–7.
Department of Health and Social Care. UK 5 year antimicrobial resistance (AMR) strategy 2019–2024.
Ashiru-Oredope D, Sharland M, Charani E, McNulty C, Cooke J. Improving the quality of antibiotic prescribing in the NHS by developing a new Antimicrobial Stewardship Programme: Start Smart—Then Focus. J Antimicrob Chemother. 2012;67(suppl_1):i51–63.
Dellit TH, Owens RC, McGowan JE, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159–77.
Baysari MT, Lehnbom EC, Li L, Hargreaves A, Day RO, Westbrook JI. The effectiveness of information technology to improve antimicrobial prescribing in hospitals: a systematic review and meta-analysis. Int J Med Inform. 2016;92:15–34.
Carracedo-Martinez E, Gonzalez-Gonzalez C, Teixeira-Rodrigues A, Prego-Dominguez J, Takkouche B, Herdeiro MT, et al. Computerized clinical decision support systems and antibiotic prescribing: a systematic review and meta-analysis. Clin Ther. 2019;41:552–81.
Ibrahim OM, Polk RE. Antimicrobial use metrics and benchmarking to improve stewardship outcomes: methodology, opportunities, and challenges. Infect Dis Clin. 2014;28(2):195–214.
Department of Health. The path of least resistance 1998.
Department of Health. UK antimicrobial resistance strategy and action plan 2000.
Public Health England. English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) 2018 to 2019.
Okumura LM, Veroneze I, Bugardt CI, Fragoso MF. Effects of a computerised provider order entry and a clinical decision support system to improve cefazolin use in surgical prophylaxis: a cost saving analysis. Pharm Pract. 2016. https://doi.org/10.18549/PharmPract.2016.03.717.
Thursky KA, Buising KL, Bak N, Macgregor L, Street AC, Macintyre CR, et al. Reduction of broad-spectrum antibiotic use with computerised decision support in an intensive care unit. Int J Qual Health Care. 2006;18(3):224–31.
Thursky K. Use of computerised decision support systems to improve antibiotic prescribing. Expert Rev Anti-infect Ther. 2006;4(3):491–507.
Sintchenko V, Iredell JR, Gilbert GL, Coiera E. Handheld computer-based decision support reduces patient length of stay and antibiotic prescribing in critical care. J Am Med Inform Assoc. 2005;12(4):398–402.
Zaidi STR, Marriott JL. Barriers and facilitators to adoption of a web-based antibiotic decision support system. South Med Rev. 2012;5(2):42.
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This research is part of a Ph.D. project. The Ph.D. student, Dr. Fares Albahar is sponsored and funded by Zarqa University, Jordan.
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The Author(s); Fares Albahar, John Marriott, Chris Curtis, and Hamza Alhamad declare that they have no conflicts of interest to disclose.
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Al Bahar, F., Curtis, C.E., Alhamad, H. et al. The impact of a computerised decision support system on antibiotic usage in an English hospital. Int J Clin Pharm 42, 765–771 (2020). https://doi.org/10.1007/s11096-020-01022-3
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DOI: https://doi.org/10.1007/s11096-020-01022-3