Computerized Decision Support System for Antibiotic Treatment

Status Completed

Clinical Trial Summary

We developed a computerized decision support system for prescription of antibiotics to inpatients. The purpose of the study is to assess the performance of the system in different wards, in three different hospitals, in three countries.

Clinical Trial Description

Antibiotic treatment for suspected moderate to severe bacterial infections is usually initiated empirically, prior to identification of the causative pathogen. Appropriate treatment, that is matching in-vitro susceptibilities of subsequently isolated pathogens, reduces the overall fatality rate of severe infections with adjusted odds ratios varying between 1.6 and 6.9. In the same studies, 20-50% of patients were given inappropriate empirical antibiotic treatment.

We developed a computerized decision support system (TREAT) based on a causal probabilistic network to improve antibiotic treatment of inpatients. The aims of the system were to improve the rate of appropriate antibiotic treatment, thereby reducing mortality, and to route antibiotic use towards ecologically economical antibiotics as determined by local resistance profiles. The system can be calibrated to different locations.

The TREAT system was tested in a multi-center observational cohort study. The study proved the system safe and effective. TREAT prescribed appropriate antibiotic treatment to 70% of patients, 58% of whom were treated appropriately by physicians. TREAT used a narrow antibiotic formulary and at lower costs, mainly lowering costs assigned by the model to future resistance. The system performed well in three different countries (Israel, Italy and Germany).

We then proceeded to assess the effect of TREAT on the management of inpatients in these sites in a cluster randomized controlled trial. We used wards as the unit of randomization to avoid contamination through education of users by the system, and to benefit from the interaction of TREAT with the ward as a whole.

Comparison: the TREAT system was installed in intervention wards and its use was offered to physicians at the time of empirical antibiotic treatment. Physicians were asked to inspect TREAT’s result interface. The final choice of antibiotic treatment was theirs. Control wards had no access to the system. We assessed outcomes in intervention vs. control wards with regard to patient outcomes, appropriateness of antibiotic treatment and antibiotic costs. ;

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

Clinical Trial Details

NCT number	NCT00233376
Study type	Interventional
Source	Rabin Medical Center
Contact
Status	Completed
Phase	Phase 3
Start date	May 2004
Completion date	November 2004

View Details

See also
Status	Clinical Trial	Phase
Completed	`NCT05547646` - The Prevalence of Healthcare-associated Infection in Medical Intensive Care Units in Tunisia
Completed	`NCT00195351` - Study Comparing Tigecycline Versus Ceftriaxone Sodium Plus Metronidazole in Complicated Intra-abdominal Infection	Phase 4
Completed	`NCT02511925` - Electronic Hand Hygiene Monitoring and ICU Infection Rates	N/A
Completed	`NCT00079885` - Study Evaluating Tigecycline vs Levofloxacin in Hospitalized With Community-Acquired Pneumonia	Phase 3
Completed	`NCT00156377` - Prophylaxis With Intranasal Mupirocin for Prevention of S. Aureus Infections	Phase 4
Completed	`NCT00081744` - Study Comparing Tigecycline to Imipenem/Cilastatin in Complicated Intra-Abdominal Infections in Hospitalized Subjects	Phase 3
Completed	`NCT00965848` - A Safety and Efficacy Study of Doripenem in Participants With Nosocomial Pneumonia, Complicated Intra-Abdominal Infections and Urinary Tract Infections	Phase 4
Completed	`NCT01640925` - Trial of 2% Chlorhexidine Bathing on Nosocomial Infections in the Surgical Intensive Care Unit	N/A
Completed	`NCT00081575` - Study Comparing Tigecycline vs. Levofloxacin in Subjects Hospitalized With Community-Acquired Pneumonia	Phase 3
Recruiting	`NCT04900298` - Reducing Intraoperative ESKAPE Transmission Through Use of a Personal Hand Hygiene System	N/A
Enrolling by invitation	`NCT03910920` - Cross Transmissions of Pseudomonas Aeruginosa Between Children From a Same Cystic Fibrosis Center.
Not yet recruiting	`NCT01245829` - A Randomized Trial Comparing Matt and Antimicrobial Cellomed Laminates	N/A
Recruiting	`NCT06194903` - Randomized Pilot Study Evaluating Isopropyl Alcohol and UVC Rays in Disinfection of Cell Phones	N/A
Active, not recruiting	`NCT00197847` - Infection Surveillance in Intensive Care Patients	N/A
Completed	`NCT01114347` - Prevention of Nosocomial E. Coli Infections After Placement of an Indwelling Catheter During Pelvic Surgery: an Evaluation of Cranberry Gel Capsules	Phase 2
Recruiting	`NCT05326945` - Use of Disposable Cuff Cover to Prevent Carriage of Pathogen Microorganisms Originated by Cuffs	N/A
Completed	`NCT03025672` - Evaluation of the Cost of a Nosocomial Infection With Clostridium Difficile	N/A
Recruiting	`NCT00645723` - Intravenous Colistin Versus Intravenous Colistin Plus Nebulized Colistin in VAP Due MDR Acinetobacter Baumannii	Phase 3
Recruiting	`NCT06392568` - Epidemiological Features of Emergent Highly Resistant Bacteria in Tunisian Intensive Care Units