Kofoed Kristian, Zalounina Alina, Andersen Ove, Lisby Gorm, Paul Mical, Leibovici Leonard, Andreassen Steen
Clinical Research Centre and Department of Infectious Diseases, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
J Antimicrob Chemother. 2009 Feb;63(2):400-4. doi: 10.1093/jac/dkn504. Epub 2008 Dec 17.
To evaluate a decision support system (TREAT) for guidance of empirical antimicrobial therapy in an environment with a low prevalence of resistant pathogens.
A retrospective trial of TREAT has been performed at Copenhagen University, Hvidovre Hospital. The cohort of patients included adults with systemic inflammation and suspicion of community-acquired bacterial infection. The empirical antimicrobial treatment recommended by TREAT was compared with the empirical antimicrobial treatment prescribed by the first attending clinical physician.
Out of 171 patients recruited, 161 (65 with microbiologically documented infections) fulfilled the inclusion criteria of TREAT. Coverage achieved by TREAT was significantly higher than that by clinical practice (86% versus 66%, P = 0.007). There was no significant difference in the cost of future resistance between treatments chosen by TREAT and those by physicians. The direct expenses for antimicrobials were higher in TREAT when including patients without antimicrobial treatment, while there was no significant difference otherwise. The cost of side effects was significantly lower using TREAT.
The results of the study suggest that TREAT can improve the appropriateness of antimicrobial therapy and reduce the cost of side effects in regions with a low prevalence of resistant pathogens, however, at the expense of increased use of antibiotics.
在耐药病原体低流行率的环境中，评估一种用于指导经验性抗菌治疗的决策支持系统（TREAT）。
在哥本哈根大学赫勒乌医院进行了一项关于TREAT的回顾性试验。患者队列包括患有全身炎症且怀疑社区获得性细菌感染的成年人。将TREAT推荐的经验性抗菌治疗与首位主治临床医生开具的经验性抗菌治疗进行比较。
在招募的171名患者中，161名（65名有微生物学记录的感染患者）符合TREAT的纳入标准。TREAT实现的覆盖范围显著高于临床实践（86%对66%，P = 0.007）。TREAT选择的治疗与医生选择的治疗在未来耐药成本方面无显著差异。当纳入未接受抗菌治疗的患者时，TREAT中抗菌药物的直接费用更高，否则无显著差异。使用TREAT时副作用成本显著更低。
研究结果表明，在耐药病原体低流行率的地区，TREAT可提高抗菌治疗的合理性并降低副作用成本，然而，代价是抗生素使用增加。
