Schaut Marius, Schaefer Marion, Trost Ulrike, Sander André
Pharmacist, MSc, Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, and ID Information und Dokumentation im Gesundheitswesen GmbH & Co. KGaA, Platz vor dem Neuen Tor 2, 10115 Berlin, Germany.
Pharmacist, Prof, Dr, Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Germs. 2022 Jun 30;12(2):203-213. doi: 10.18683/germs.2022.1323. eCollection 2022 Jun.
Decision-making for inpatient antibiotic prescribing is complex due to many considerations to be taken. So far, clinical decision support systems (CDSS) have been rarely used in antibiotic stewardship (ABS) and even less integrated in computerized physician order entry systems (CPOE).
We developed a guideline-based, CPOE-integrated CDSS (ID ANTIBIOTICS) to support antibiotic selection and dosing. We compared routine antibiotic inpatient prescribing data with CDSS-generated recommendations in the initial antibiotic selection, the duration of therapies, and costs. Finally, we assessed possible benefits of the CDSS by its performance in German ABS-guideline quality indicators (ABS-QIs).
The requirements of several ABS-QIs can be supported with ID ANTIBIOTICS: electronic local guidelines, electronic decision-support, renal dosage adjustments, local guideline-based initial selection (all not quantified), and therapy durations for the treatment of pneumonia (significantly) without increasing costs. Performance in ABS-QIs for extensive therapies for community-acquired pneumonia could be improved with the CDSS by 20.2% (OR 0.134; 95% CI: 0.101-0.178); for hospital-acquired pneumonia by 3.7% (OR 0.742; 95% CI: 0.629-0.877). There was no difference in median daily drug costs between real-world prescriptions and CDSS recommendations (both: € 4.78, p=0.081).
In retrospective analyses, antibiotic CDSS can show possible performance in antibiotic stewardship through quality indicators (ABS-QIs). Further research and pilot testing of the software are needed to provide more insights into ABS-QI evaluation, user acceptance, and real-world effectiveness. Deep integration of antibiotic CDSS into existing medication processes without using multiple systems could contribute to the necessary acceptance of clinical practitioners.
由于需要考虑诸多因素，住院患者抗生素处方的决策十分复杂。到目前为止，临床决策支持系统（CDSS）在抗生素管理（ABS）中很少使用，在计算机化医师医嘱录入系统（CPOE）中的整合程度更低。
我们开发了一种基于指南的、整合于CPOE的CDSS（ID抗生素），以支持抗生素的选择和剂量确定。我们将常规抗生素住院处方数据与CDSS在初始抗生素选择、治疗持续时间和成本方面生成的建议进行了比较。最后，我们通过CDSS在德国ABS指南质量指标（ABS-QIs）方面的表现评估了其可能带来的益处。
ID抗生素可以支持多项ABS-QIs的要求：电子本地指南、电子决策支持、肾脏剂量调整、基于本地指南的初始选择（均未量化）以及肺炎治疗的持续时间（显著），且不会增加成本。CDSS可将社区获得性肺炎广泛治疗的ABS-QIs表现提高20.2%（OR 0.134；95% CI：0.101 - 0.178）；医院获得性肺炎提高3.7%（OR 0.742；95% CI：0.629 - 0.877）。实际处方与CDSS建议之间的日均药物成本中位数无差异（均为4.78欧元，p = 0.081）。
在回顾性分析中，抗生素CDSS可通过质量指标（ABS-QIs）展现其在抗生素管理方面的可能表现。需要对该软件进行进一步研究和试点测试，以更深入了解ABS-QI评估、用户接受度和实际效果。将抗生素CDSS深度整合到现有用药流程中而不使用多个系统，可能有助于临床医生的必要接受。
