Subscribe to RSS
DOI: 10.1055/a-2054-0270
Digital Antimicrobial Stewardship Decision Support to Improve Antimicrobial Management
Funding U.S. Department of Health and Human Services; National Institutes of Health; U.S. National Library of Medicine; NLM Institutional Training grant number: T15LM007092-30.Abstract
Objectives We sought to create a digital application to support clinicians in empiric and pathogen-directed antibiotic ordering based on local susceptibility patterns and evidence-based treatment durations, thereby promoting antimicrobial stewardship.
Methods We formed a multidisciplinary team that met bimonthly from 2017 to 2018 to design and construct a web-based antimicrobial stewardship platform called Antibiogram + . We used an iterative and agile technical development process with frequent feedback from clinicians.
Results Antibiogram+ is an online tool, accessible via the electronic health record and hospital intranet, which offers institutional antibiotic susceptibilities for major pathogens, recommendations for empiric antibiotic selection and treatment durations for common pediatric conditions, antimicrobial dosing and monitoring guidance, and links to other internal clinical decision support resources. The tool was accessed 11,823 times with 492 average monthly views during the first 2 years after release. Compared with use of a preexisting print antibiogram and dosing card, pediatric residents more frequently reported “often” being sure of antibiotic dosing with Antibiogram+ (58 vs. 15%, p < 0.01). Respondents also reported improved confidence in choice of antibiotic, but this finding did not reach statistical significance (55 vs. 35%, p = 0.26).
Conclusion We report the successful development of a digital antimicrobial stewardship platform with consistent rates of access during the first 2 years following release and improved provider comfort with antibiotic management.
Keywords
microbial sensitivity tests - antimicrobial stewardship - clinical decision support systemsProtection of Human and Animal Subjects
The Boston Children's Hospital Institutional Review Board reviewed and approved this study.
Publication History
Received: 19 December 2022
Accepted: 12 March 2023
Accepted Manuscript online:
14 March 2023
Article published online:
31 May 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Walker B, Barrett S, Polasky S. et al. Environment. Looming global-scale failures and missing institutions. Science 2009; 325 (5946): 1345-1346
- 2 Centers for Disease Control and Prevention (U.S.). Antibiotic Resistance Threats in the United States, 2019. Centers for Disease Control and Prevention (U.S.); 2019.
- 3 Tamma PD, Cosgrove SE. Antimicrobial stewardship. Infect Dis Clin North Am 2011; 25 (01) 245-260
- 4 Baur D, Gladstone BP, Burkert F. et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis 2017; 17 (09) 990-1001
- 5 Karanika S, Paudel S, Grigoras C, Kalbasi A, Mylonakis E. Systematic review and meta-analysis of clinical and economic outcomes from the implementation of hospital-based antimicrobial stewardship programs. Antimicrob Agents Chemother 2016; 60 (08) 4840-4852
- 6 Hyun DY, Hersh AL, Namtu K. et al. Antimicrobial stewardship in pediatrics: how every pediatrician can be a steward. JAMA Pediatr 2013; 167 (09) 859-866
- 7 Barlam TF, Cosgrove SE, Abbo LM. et al. Implementing an antibiotic stewardship program: guidelines by the infectious diseases Society of America and the Society for healthcare epidemiology of America. Clin Infect Dis 2016; 62 (10) e51-e77
- 8 Kollef M. Appropriate empirical antibacterial therapy for nosocomial infections: getting it right the first time. Drugs 2003; 63 (20) 2157-2168
- 9 Four Moments of Antibiotic Decision Making | Agency for Healthcare Research and Quality. Accessed October 5, 2022 at: https://www.ahrq.gov/antibiotic-use/acute-care/four-moments/index.html
- 10 Tamma PD, Miller MA, Cosgrove SE. Rethinking how antibiotics are prescribed: incorporating the 4 Moments of Antibiotic Decision Making into clinical practice. JAMA 2019; 321 (02) 139-140
- 11 Deresinski S. Principles of antibiotic therapy in severe infections: optimizing the therapeutic approach by use of laboratory and clinical data. Clin Infect Dis 2007; 45 (Suppl 3): S177-S183
- 12 Ozkaynak M, Metcalf N, Cohen DM, May LS, Dayan PS, Mistry RD. Considerations for designing EHR-embedded clinical decision support systems for antimicrobial stewardship in pediatric emergency departments. Appl Clin Inform 2020; 11 (04) 589-597
- 13 Hoff BM, Ford DC, Ince D. et al. Implementation of a mobile clinical decision support application to augment local antimicrobial stewardship. J Pathol Inform 2018; 9: 10
- 14 Dahle KW, Korgenski EK, Hersh AL, Srivastava R, Gesteland PH. Clinical value of an ambulatory-based antibiogram for uropathogens in children. J Pediatric Infect Dis Soc 2012; 1 (04) 333-336
- 15 Hebert C, Ridgway J, Vekhter B, Brown EC, Weber SG, Robicsek A. Demonstration of the weighted-incidence syndromic combination antibiogram: an empiric prescribing decision aid. Infect Control Hosp Epidemiol 2012; 33 (04) 381-388
- 16 Nichols KR, Petschke AL, Webber EC, Knoderer CA. Comparison of antibiotic dosing before and after implementation of an electronic order set. Appl Clin Inform 2019; 10 (02) 229-236
- 17 Chan CT, Vo M, Carlson J, Lee T, Chang M, Hart-Cooper G. Pediatric provider utilization of a clinical decision support alert and association with HIV pre-exposure prophylaxis prescription rates. Appl Clin Inform 2022; 13 (01) 30-36
- 18 Samore MH, Bateman K, Alder SC. et al. Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial. JAMA 2005; 294 (18) 2305-2314
- 19 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
- 20 Tallman GB, Vilches-Tran RA, Elman MR. et al. Empiric antibiotic prescribing decisions among medical residents: the role of the antibiogram. Infect Control Hosp Epidemiol 2018; 39 (05) 578-583
- 21 Truong WR, Hidayat L, Bolaris MA, Nguyen L, Yamaki J. The antibiogram: key considerations for its development and utilization. JAC Antimicrob Resist 2021; 3 (02) dlab060
- 22 Hindler JF, Stelling J. Analysis and presentation of cumulative antibiograms: a new consensus guideline from the Clinical and Laboratory Standards Institute. Clin Infect Dis 2007; 44 (06) 867-873
- 23 Klinker KP, Hidayat LK, DeRyke CA, DePestel DD, Motyl M, Bauer KA. Antimicrobial stewardship and antibiograms: importance of moving beyond traditional antibiograms. Ther Adv Infect Dis 2021;8:20499361211011373
- 24 Mermel LA, Jefferson J, Devolve J. Knowledge and use of cumulative antimicrobial susceptibility data at a university teaching hospital. Clin Infect Dis 2008; 46 (11) 1789
- 25 Evans CT, Rogers TJ, Burns SP, Lopansri B, Weaver FM. Knowledge and use of antimicrobial stewardship resources by spinal cord injury providers. PM R 2011; 3 (07) 619-623
- 26 Selekman RE, Allen IE, Copp HL. Determinants of practice patterns in pediatric UTI management. J Pediatr Urol 2016; 12 (05) 308.e1-308.e6
- 27 Simpao AF, Ahumada LM, Larru Martinez B. et al. Design and implementation of a visual analytics electronic antibiogram within an electronic health record system at a tertiary pediatric hospital. Appl Clin Inform 2018; 9 (01) 37-45
- 28 Firstline. Firstline - Antimicrobial Stewardship Mobile App. Accessed October 10, 2022 at: https://firstline.org/antimicrobial-stewardship/
- 29 Stewardship Assist - Antimicrobial Stewardship App. Sanford Guide - Antimicrobial Stewardship. Accessed October 10, 2022 at: https://www.sanfordguide.com/stewardship-assist/
- 30 MicroGuide. App Store. Accessed October 10, 2022 at: https://apps.apple.com/gb/app/microguide/id447171786
- 31 Helou RI, Foudraine DE, Catho G, Peyravi Latif A, Verkaik NJ, Verbon A. Use of stewardship smartphone applications by physicians and prescribing of antimicrobials in hospitals: a systematic review. PLoS One 2020; 15 (09) e0239751
- 32 Manifesto for Agile Software Development. Accessed December 16, 2022 at: https://agilemanifesto.org/