Article Text

Download PDFPDF

Long-term effect of computer-assisted decision support for antibiotic treatment in critically ill patients: a prospective ‘before/after’ cohort study
  1. I Nachtigall1,
  2. S Tafelski1,
  3. M Deja1,
  4. E Halle2,
  5. M C Grebe1,
  6. A Tamarkin1,
  7. A Rothbart1,
  8. A Uhrig3,
  9. E Meyer4,
  10. L Musial-Bright5,
  11. K D Wernecke6,
  12. C Spies1
  1. 1Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
  2. 2Charité-Universitaetsmedizin Berlin, Institute for Microbiology and Hygiene, Berlin, Germany
  3. 3Department of Internal Medicine, Infectious Diseases and Respiratory Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
  4. 4Charité Universitaetsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
  5. 5Department of Cardiology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
  6. 6Charité-Universitaetsmedizin Berlin, Institute of Medical Biometrics, and SOSTANA GmbH, Berlin, Germany
  1. Correspondence to Professor C Spies; claudia.spies{at}


Objectives Antibiotic resistance has risen dramatically over the past years. For individual patients, adequate initial antibiotic therapy is essential for clinical outcome. Computer-assisted decision support systems (CDSSs) are advocated to support implementation of rational anti-infective treatment strategies based on guidelines. The aim of this study was to evaluate long-term effects after implementation of a CDSS.

Design This prospective ‘before/after’ cohort study was conducted over four observation periods within 5 years. One preinterventional period (pre) was compared with three postinterventional periods: directly after intensive implementation efforts (post1), 2 years (post2) and 3 years (post3) after implementation.

Setting Five anaesthesiological-managed intensive care units (ICU) (one cardiosurgical, one neurosurgical, two interdisciplinary and one intermediate care) at a university hospital.

Participants Adult patients with an ICU stay of >48 h were included in the analysis. 1316 patients were included in the analysis for a total of 12 965 ICU days.

Intervention Implementation of a CDSS.

Outcome measures The primary end point was percentage of days with guideline adherence during ICU treatment. Secondary end points were antibiotic-free days and all-cause mortality compared for patients with low versus high guideline adherence.

Main results Adherence to guidelines increased from 61% prior to implementation to 92% in post1, decreased in post2 to 76% and remained significantly higher compared with baseline in post3, with 71% (p=0.178). Additionally, antibiotic-free days increased over study periods. At all time periods, mortality for patients with low guideline adherence was higher with 12.3% versus 8% (p=0.014) and an adjusted OR of 1.56 (95% CI 1.05 to 2.31).

Conclusions Implementation of computerised regional adapted guidelines for antibiotic therapy is paralleled with improved adherence. Even without further measures, adherence stayed high for a longer period and was paralleled by reduced antibiotic exposure. Improved guideline adherence was associated with reduced ICU mortality.

Trial registration number ISRCTN54598675.

  • Stewardship program
  • Evidence based medicine
  • Antibiotic therapy
  • Computer-assisted decision support systems

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.