Demonchy Elisa, Dufour Jean-Charles, Gaudart Jean, Cervetti Emmanuel, Michelet Pierre, Poussard Nicolas, Levraut Jacques, Pulcini Céline
Faculté de Médecine, Université Nice-Sophia Antipolis, Nice, France Service d'Infectiologie, CHU de Nice, Nice, France.
BIOSTIC, Pôle de Santé Publique, Assistance Publique-Hôpitaux de Marseille, Marseille, France UMR912 SESSTIM (AMU-INSERM-IRD-AMSE), Aix-Marseille University, Marseille, France.
J Antimicrob Chemother. 2014 Oct;69(10):2857-63. doi: 10.1093/jac/dku191. Epub 2014 Jun 4.
Urinary tract infections (UTIs) are one of the leading reasons for antibiotic prescriptions in emergency departments (EDs), with half of these antibiotics being inappropriately prescribed. Our objective was to assess the impact of a computerized decision support system (CDSS) on compliance with guidelines on empirical antibiotic prescriptions (antibiotic and duration) for UTIs in EDs.
A multicentre prospective before-and-after controlled interventional study was conducted from 19 March to 28 October 2012. All adults diagnosed with community-acquired UTIs (cystitis, pyelonephritis or prostatitis) at three French EDs were included. The antibiotic therapy was considered compliant with guidelines if the antibiotic and the duration prescribed were in accordance with the national guidelines. Data were collected using electronic medical records. Paired tests were used when comparing periods within each ED and global analyses used multivariate logistic mixed models.
Nine hundred and twelve patients were included during the 30 week study period. The CDSS was used in 59% of cases (182/307). The CDSS intervention improved the compliance of antibiotic prescriptions in only one ED in a bivariate analysis (absolute increase +20%, P = 0.007). The choice of the antibiotic was improved in multivariate analyses but only when the CDSS was used [OR = 1.94 (95% CI 1.13-3.32)]. The CDSS also changed the initial diagnosis in 23% of cases, in all three EDs.
The CDSS only partially improved compliance with guidelines on antibiotic prescriptions in UTIs.
尿路感染（UTIs）是急诊科抗生素处方的主要原因之一，其中一半的抗生素处方存在不合理之处。我们的目的是评估计算机决策支持系统（CDSS）对急诊科UTIs经验性抗生素处方（抗生素及疗程）指南依从性的影响。
于2012年3月19日至10月28日进行了一项多中心前瞻性前后对照干预研究。纳入法国三家急诊科所有诊断为社区获得性UTIs（膀胱炎、肾盂肾炎或前列腺炎）的成年人。如果所开的抗生素及疗程符合国家指南，则认为抗生素治疗符合指南。数据通过电子病历收集。在比较每个急诊科内的不同时期时采用配对检验，整体分析采用多变量逻辑混合模型。
在为期30周的研究期间共纳入912例患者。59%的病例（182/307）使用了CDSS。在双变量分析中，CDSS干预仅在一家急诊科提高了抗生素处方的依从性（绝对增加+20%，P = 0.007）。在多变量分析中抗生素的选择有所改善，但仅在使用CDSS时[比值比=1.94（95%可信区间1.13 - 3.32）]。在所有三家急诊科中，CDSS还在23%的病例中改变了初始诊断。
CDSS仅部分提高了UTIs抗生素处方指南的依从性。
