计算机化决策支持对医院抗生素使用的有效性：一项系统评价。
The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review.
作者信息
Curtis Christopher E, Al Bahar Fares, Marriott John F
机构信息
School of Pharmacy, College of Medical & Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom.
出版信息
PLoS One. 2017 Aug 24;12(8):e0183062. doi: 10.1371/journal.pone.0183062. eCollection 2017.
BACKGROUND
Inappropriate antimicrobial use has been shown to be an important determinant of the emergence of antimicrobial resistance (AMR). Health information technology (HIT) in the form of Computerised Decision Support (CDS) represents an option for improving antimicrobial prescribing and containing AMR.
OBJECTIVES
To evaluate the evidence for CDS in improving quantitative and qualitative measures of antibiotic prescribing in inpatient hospital settings.
METHODS
A systematic literature search was conducted of articles published from inception to 20th December 2014 using eight electronic databases: MEDLINE, EMBASE, PUBMED, Web of Science, CINAHL, Cochrane Library, HMIC and PsychINFo. An updated systematic literature search was conducted from January 1st 2015 to October 1st 2016 using PUBMED. The search strategy used combinations of the following terms: (electronic prescribing) OR (clinical decision support) AND (antibiotic or antibacterial or antimicrobial) AND (hospital or secondary care or inpatient). Studies were evaluated for quality using a 10-point rating scale.
RESULTS
Eighty-one studies were identified matching the inclusion criteria. Seven outcome measures were evaluated: adequacy of antibiotic coverage, mortality, volume of antibiotic usage, length of stay, antibiotic cost, compliance with guidelines, antimicrobial resistance, and CDS implementation and uptake. Meta-analysis of pooled outcomes showed CDS significantly improved the adequacy of antibiotic coverage (n = 13; odds ratio [OR], 2.11 [95% CI, 1.67 to 2.66, p ≤ 0.00001]). Also, CDS was associated with marginally lowered mortality (n = 20; OR, 0.85 [CI, 0.75 to 0.96, p = 0.01]). CDS was associated with lower antibiotic utilisation, increased compliance with antibiotic guidelines and reductions in antimicrobial resistance. Conflicting effects of CDS on length of stay, antibiotic costs and system uptake were also noted.
CONCLUSIONS
CDS has the potential to improve the adequacy of antibiotic coverage and marginally decrease mortality in hospital-related settings.
背景
抗菌药物的不当使用已被证明是抗菌药物耐药性（AMR）出现的一个重要决定因素。以计算机化决策支持（CDS）形式存在的健康信息技术（HIT）是改善抗菌药物处方和控制AMR的一种选择。
目的
评估CDS在改善住院医院环境中抗生素处方的定量和定性指标方面的证据。
方法
使用八个电子数据库（MEDLINE、EMBASE、PUBMED、科学网、护理学与健康照护领域数据库、考科蓝图书馆、英国医学期刊数据库卫生管理版和心理学文摘数据库）对从创刊到2014年12月20日发表的文章进行系统文献检索。使用PUBMED对2015年1月1日至2016年10月1日进行了更新的系统文献检索。检索策略使用了以下术语的组合：（电子处方）或（临床决策支持）与（抗生素或抗菌剂或抗菌药物）与（医院或二级医疗或住院患者）。使用10分制评分量表对研究质量进行评估。
结果
确定了81项符合纳入标准的研究。评估了七个结果指标：抗生素覆盖的充分性、死亡率、抗生素使用量、住院时间、抗生素成本、指南依从性、抗菌药物耐药性以及CDS的实施和采用情况。汇总结果的荟萃分析表明，CDS显著提高了抗生素覆盖的充分性（n = 13；比值比[OR]，2.11[95%置信区间，1.67至2.66，p≤0.00001]）。此外，CDS与死亡率略有降低相关（n = 20；OR，0.85[CI，0.75至0.96，p = 0.01]）。CDS与较低的抗生素利用率、更高的抗生素指南依从性以及抗菌药物耐药性的降低相关。还注意到CDS对住院时间、抗生素成本和系统采用的影响存在冲突。
结论
CDS有潜力提高抗生素覆盖的充分性，并在医院相关环境中略微降低死亡率。
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