Taş Zahit, Metan Gökhan, Telli Dizman Gülçin, Yavuz Eren, Dizdar Ömer, Büyükaşık Yahya, Uzun Ömrüm, Akova Murat
Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey.
Hemosoft Software Development Department, Ankara 06800, Turkey.
Antibiotics (Basel). 2024 Sep 2;13(9):832. doi: 10.3390/antibiotics13090832.
We investigated the influence of a local guideline on the quality of febrile neutropenia (FN) management and the applicability of a computerized decision support system (CDSS) using real-life data. The study included 227 FN patients between April 2016 and January 2019. The primary outcome measure was the achievement of a 20% increase in the rate of appropriate empirical treatment of FN in bacteremic patients. The compatibility of the CDSS (the development of which was completed in November 2021) with local protocols was tested using standard patient scenarios and empirical antibiotic recommendations for bacteremic FN patients. In total, 91 patients were evaluated before (P1: between April 2016 and May 2017) and 136 after (P2: between May 2017 and January 2019) the guideline's release (May 2017). The demographic characteristics were similar. Appropriate empirical antibacterial treatment was achieved in 58.3% of P1 and 88.1% of P2 patients ( = 0.006). The need for escalation of antibacterial treatment was significantly lower in P2 (49.5% vs. 35.3%; = 0.03). In P2, the performance of the CDSS and consulting physicians was similar (CDSS 88.8% vs. physician 88.83%; = 1) regarding appropriate empirical antibacterial treatment. The introduction of the local guideline improved the appropriateness of initial empirical treatment and reduced escalation rates in FN patients. The high rate of compliance of the CDSS with the local guideline-based decisions in P2 highlights the usefulness of the CDSS for these patients.
我们利用实际数据研究了当地指南对发热性中性粒细胞减少症（FN）管理质量的影响以及计算机化决策支持系统（CDSS）的适用性。该研究纳入了2016年4月至2019年1月期间的227例FN患者。主要结局指标是菌血症患者中FN适当经验性治疗率提高20%。使用标准患者场景和针对菌血症FN患者的经验性抗生素推荐，测试了CDSS（于2021年11月完成开发）与当地方案的兼容性。总共91例患者在指南发布前（P1：2016年4月至2017年5月）接受了评估，136例患者在指南发布后（P2：2017年5月至2019年1月）（2017年5月）接受了评估。人口统计学特征相似。P1组58.3%的患者和P2组88.1%的患者实现了适当的经验性抗菌治疗（P = 0.006）。P2组抗菌治疗升级的需求显著更低（49.5%对35.3%；P = 0.03）。在P2组中，就适当的经验性抗菌治疗而言，CDSS和会诊医生的表现相似（CDSS为88.8%，医生为88.83%；P = 1）。当地指南的引入提高了FN患者初始经验性治疗的适当性并降低了升级率。P2组中CDSS与基于当地指南的决策的高依从率突出了CDSS对这些患者的有用性。
