Cluster randomized trial; Audit and feedback; Antibiotic use; Antibiotic indicators; Antibiotic stewardship; Computerized decision support
Catho Gaud, Centemero Nicolo S., Waldispühl Suter Brigitte, Vernaz Nathalie, Portela Javier, Da Silva Serge, Valotti Roberta, Coray Valentina, Pagnamenta Francesco, Ranzani Alice, Piuz Marie-Françoise, Elzi Luigia, Meyer Rodolphe, Bernasconi Enos, Huttner Benedikt D. (2021), How to Develop and Implement a Computerized Decision Support System Integrated for Antimicrobial Stewardship? Experiences From Two Swiss Hospital Systems, in Frontiers in Digital Health
Catho Gaud, Centemero Nicolò Saverio, Catho Heloïse, Ranzani Alice, Balmelli Carlo, Landelle Caroline, Zanichelli Veronica, Huttner Benedikt David (2020), Factors determining the adherence to antimicrobial guidelines and the adoption of computerised decision support systems by physicians: A qualitative study in three European hospitals, in International Journal of Medical Informatics
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(2018), Study protocol for a multicentre, cluster randomised, superiority trial evaluating the impact of computerised decision support, audit and feedback on antibiotic use: the COMPuterized Antibiotic Stewar, in BMJ Open
We propose a multicentre cluster-randomised controlled superiority trial of a multimodal computerised decision-support system (CDSS) integrated into the electronic health record (EHR) to improve antibiotic use. Acute-care wards in three Swiss hospitals (Geneva, Lugano, Bellinzona) will be randomized 1:1 to either standard of care or a multimodal CDSS intervention consisting of computerized decision-support for empiric antimicrobial use, systematic reassessment of empiric treatment on day four of antibiotic treatment and automated feedback of quality indicators throughout the 12-month intervention period. The primary outcome will be the reduction of overall antibiotic use, as measured by days of therapy per hospital admission. Secondary outcomes will be the impact of the CDSS on antibiotic prescribing quality, economic outcomes and patient-related outcomes, including possible inadvertent outcomes such as changes in mortality, intensive care unit admission or readmissions. One of the strategies that will be encouraged by the intervention is antibiotic de-escalation, yet the impact of this strategy on antimicrobial resistance is unclear. We therefore propose a sub-study that aims to assess the impact of antibiotic de-escalation on the human intestinal microbiome and antibiotic resistance gene abundance using a propensity score matched case-control study nested in a prospective cohort study.