Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit

Thursky, Karin A., Buising, Kirsty L., Bak, Narin, MacGregor, Lachlan, Street, Alan C., MacIntyre, C. Raina, Presneill, Jeffrey J., Cade, John F. and Brown, Graham V. (2006) Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit. International Journal for Quality in Health Care, 18 3: 224-231. doi:10.1093/intqhc/mzi095

Author Thursky, Karin A.
Buising, Kirsty L.
Bak, Narin
MacGregor, Lachlan
Street, Alan C.
MacIntyre, C. Raina
Presneill, Jeffrey J.
Cade, John F.
Brown, Graham V.
Title Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit
Journal name International Journal for Quality in Health Care   Check publisher's open access policy
ISSN 1353-4505
Publication date 2006-06
Sub-type Article (original research)
DOI 10.1093/intqhc/mzi095
Volume 18
Issue 3
Start page 224
End page 231
Total pages 8
Place of publication Cary, NC United States
Publisher Oxford University Press
Language eng
Formatted abstract
Objective. To implement and evaluate the effect of a computerized decision support tool on antibiotic use in an intensive care unit (ICU).
Design. Prospective before-and-after cohort study.
Setting. Twenty-four bed tertiary hospital adult medical/surgical ICU.
Participants. All consecutive patients from May 2001 to November 2001 (N = 524) and March 2002 to September 2002 (N = 536).
Intervention. A real-time microbiology browser and computerized decision support system for isolate directed antibiotic prescription.
Main outcome measures. Number of courses of antibiotic prescribed, antibiotic utilization (defined daily doses (DDDs)/100 ICU bed-days), antibiotic susceptibility mismatches, and system uptake.
Results. There was a significant reduction in the proportion of patients prescribed carbapenems [odds ratio (OR) = 0.61, 95% confidence interval (CI) = 0.39–0.97, P = 0.04], third-generation cephalosporins (OR = 0.58, 95% CI = 0.42–0.79, P = 0.001),
and vancomycin (OR = 0.67, 95% CI = 0.45–1.00, P = 0.05) after adjustment for risk factors including Apache II score, suspected infection, positive microbiology, intubation, and length of stay. The decision support tool was associated with a 10.5%
reduction in both total antibiotic utilization (166–149 DDDs/100 ICU bed days) and the highest volume broad-spectrum antibiotics.  There were fewer susceptibility mismatches for initial antibiotic therapy (OR = 0.63, 95% CI = 0.39–0.98, P = 0.02)
and increased de-escalation to narrower spectrum antibiotics. Uptake of the program was high with 6028 access episodes during the 6-month evaluation period.
Conclusions. This tool streamlined collation and clinical use of microbiology results and integrated into the daily ICU workflow.  Its introduction was accompanied by a reduction in both total and broad-spectrum antibiotic use and an increase in the
number of switches to narrower spectrum antibiotics.
Keyword Antibiotic use
Computerized decision support
Intensive care
Antimicrobial Therapy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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