Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Lucerne, Lucerne, Switzerland.
J Antimicrob Chemother. 2023 Sep 5;78(9):2297-2305. doi: 10.1093/jac/dkad235.
Measuring the appropriateness of antibiotic use is crucial for antibiotic stewardship (ABS) programmes to identify targets for interventions.
To assess the technical feasibility of converting electronic medical record (EMR) data into ABS indicators.
In this observational feasibility study covering a period of 2 years, the EMRs of patients hospitalized at a large non-university hospital network and receiving at least one dose of a systemic antibiotic were included. ABS indicators measuring steps in the process of antibiotic prescription proposed by the literature were collected and rephrased or defined more specifically to be calculable if needed. Algorithms were programmed in R to convert EMR data into ABS indicators. The indicators were visualized in an interactive dashboard and the plausibility of each output value was assessed.
In total, data from 25 337 hospitalizations from 20 723 individual patients were analysed and visualized in an interactive dashboard. Algorithms could be programmed to compute 89% (25/28) of all pre-selected indicators assessing treatment decisions automatically out of EMR data, with good data quality for 46% (13/28) of these indicators. According to the data quality observed, the most important issues were (i) missing or meaningless information on indication (e.g. 'mild infection') and (ii) data processing issues such as insufficiently categorized metadata.
The calculation of indicators assessing treatment decisions from EMRs was feasible. However, better data structure and processing within EMR systems are crucial for improving the validity of the results.
衡量抗生素使用的适宜性对于抗生素管理（ABS）计划至关重要，可用于确定干预目标。
评估将电子病历（EMR）数据转换为 ABS 指标的技术可行性。
在这项为期 2 年的观察性可行性研究中，纳入了在一家大型非大学医院网络住院且至少接受一剂全身抗生素治疗的患者的 EMR。收集了文献中提出的衡量抗生素处方流程步骤的 ABS 指标，并进行重新表述或更具体地定义，如果需要，以便计算。使用 R 编程语言编写算法将 EMR 数据转换为 ABS 指标。将指标可视化在一个交互式仪表板中，并评估每个输出值的合理性。
共分析了 20723 名患者的 25337 例住院数据，并在交互式仪表板中进行了可视化。可以编写算法自动从 EMR 数据中计算出 89%（25/28）的所有预先选择的评估治疗决策的指标，其中 46%（13/28）的这些指标具有良好的数据质量。根据观察到的数据质量，最重要的问题是（i）适应症信息缺失或无意义（例如“轻度感染”），以及（ii）数据处理问题，如元数据分类不足。
从 EMR 计算评估治疗决策的指标是可行的。然而，改善 EMR 系统中的数据结构和处理对于提高结果的有效性至关重要。
