TY - JOUR

T1 - Performance of the TREAT decision support system in an environment with a low prevalence of resistant pathogens

AU - Kofoed, Kristian

AU - Zalounina, Alina

AU - Andersen, Ove

AU - Lisby, Gorm

AU - Paul, Mical

AU - Leibovici, Leonard

AU - Andreassen, Steen

AU - Kofoed, Kristian

AU - Zalounina, Alina

AU - Andersen, Ove

AU - Lisby, Gorm

AU - Paul, Mical

AU - Leibovici, Leonard

AU - Andreassen, Steen

N1 - Keywords: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Bacteria; Bacterial Infections; Cohort Studies; Community-Acquired Infections; Decision Support Systems, Clinical; Denmark; Drug Resistance, Bacterial; Female; Health Services Research; Hospitals, University; Humans; Male; Middle Aged; Retrospective Studies

PY - 2009

Y1 - 2009

N2 - OBJECTIVES: To evaluate a decision support system (TREAT) for guidance of empirical antimicrobial therapy in an environment with a low prevalence of resistant pathogens. METHODS: A retrospective trial of TREAT has been performed at Copenhagen University, Hvidovre Hospital. The cohort of patients included adults with systemic inflammation and suspicion of community-acquired bacterial infection. The empirical antimicrobial treatment recommended by TREAT was compared with the empirical antimicrobial treatment prescribed by the first attending clinical physician. RESULTS: Out of 171 patients recruited, 161 (65 with microbiologically documented infections) fulfilled the inclusion criteria of TREAT. Coverage achieved by TREAT was significantly higher than that by clinical practice (86% versus 66%, P = 0.007). There was no significant difference in the cost of future resistance between treatments chosen by TREAT and those by physicians. The direct expenses for antimicrobials were higher in TREAT when including patients without antimicrobial treatment, while there was no significant difference otherwise. The cost of side effects was significantly lower using TREAT. CONCLUSIONS: The results of the study suggest that TREAT can improve the appropriateness of antimicrobial therapy and reduce the cost of side effects in regions with a low prevalence of resistant pathogens, however, at the expense of increased use of antibiotics.

AB - OBJECTIVES: To evaluate a decision support system (TREAT) for guidance of empirical antimicrobial therapy in an environment with a low prevalence of resistant pathogens. METHODS: A retrospective trial of TREAT has been performed at Copenhagen University, Hvidovre Hospital. The cohort of patients included adults with systemic inflammation and suspicion of community-acquired bacterial infection. The empirical antimicrobial treatment recommended by TREAT was compared with the empirical antimicrobial treatment prescribed by the first attending clinical physician. RESULTS: Out of 171 patients recruited, 161 (65 with microbiologically documented infections) fulfilled the inclusion criteria of TREAT. Coverage achieved by TREAT was significantly higher than that by clinical practice (86% versus 66%, P = 0.007). There was no significant difference in the cost of future resistance between treatments chosen by TREAT and those by physicians. The direct expenses for antimicrobials were higher in TREAT when including patients without antimicrobial treatment, while there was no significant difference otherwise. The cost of side effects was significantly lower using TREAT. CONCLUSIONS: The results of the study suggest that TREAT can improve the appropriateness of antimicrobial therapy and reduce the cost of side effects in regions with a low prevalence of resistant pathogens, however, at the expense of increased use of antibiotics.

U2 - 10.1093/jac/dkn504

DO - 10.1093/jac/dkn504

M3 - Journal article

C2 - 19091808

VL - 63

SP - 400

EP - 404

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

SN - 0305-7453

IS - 2

ER -