Identifying critically ill patients at risk for inappropriate antibiotic therapy: A pilot study of a point-of-care decision support alert

Critical Care Medicine

Volumn 42, Issue 8, 2014, Pages 1832-1838

  Micek, Scott T ^a   Heard, Kevin M ^b   Gowan, Mollie ^c   Kollef, Marin H ^d  

^a ST LOUIS COLLEGE OF PHARMACY   (United States)

^b BJC HEALTHCARE   (United States)

^c ST LUKE S HOSPITAL   (United States)

^d WASHINGTON UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

antibiotics; automated medical records; outcomes; resistance; septic shock

Indexed keywords

CEFEPIME; MEROPENEM; PIPERACILLIN PLUS TAZOBACTAM; ANTIINFECTIVE AGENT;

ADULT; AGED; ANTIBIOTIC SENSITIVITY; ANTIBIOTIC THERAPY; ARTICLE; AUTOMATION; BACTERIUM ISOLATE; COHORT ANALYSIS; CRITICALLY ILL PATIENT; DECISION SUPPORT SYSTEM; FEASIBILITY STUDY; FEMALE; GRAM NEGATIVE BACTERIUM; GRAM NEGATIVE INFECTION; HEALTHCARE ASSOCIATED INFECTION; HUMAN; INAPPROPRIATE PRESCRIBING; INTENSIVE CARE UNIT; LENGTH OF STAY; MAJOR CLINICAL STUDY; MALE; MICROBIOLOGICAL EXAMINATION; MORTALITY; PILOT STUDY; POINT OF CARE DECISION SUPPORT ALERT; PRIORITY JOURNAL; RISK ASSESSMENT; VERY ELDERLY; ADOLESCENT; CLINICAL DECISION SUPPORT SYSTEM; CRITICAL ILLNESS; GRAM-NEGATIVE BACTERIAL INFECTIONS; MEDICATION ERROR; MIDDLE AGED; PHYSICIAN ORDER ENTRY SYSTEM; POINT OF CARE SYSTEM; PREVENTION AND CONTROL; STANDARDS; UNIVERSITY HOSPITAL; YOUNG ADULT;

ACADEMIC MEDICAL CENTERS; ADOLESCENT; ADULT; AGED; AGED, 80 AND OVER; ANTI-BACTERIAL AGENTS; COHORT STUDIES; CRITICAL ILLNESS; DECISION SUPPORT SYSTEMS, CLINICAL; FEMALE; GRAM-NEGATIVE BACTERIAL INFECTIONS; HUMANS; MALE; MEDICAL ORDER ENTRY SYSTEMS; MEDICATION ERRORS; MIDDLE AGED; PILOT PROJECTS; POINT-OF-CARE SYSTEMS; YOUNG ADULT;

EID: 84904738681     PISSN: 00903493     EISSN: 15300293     Source Type: Journal    
DOI: 10.1097/CCM.0000000000000337     Document Type: Article

References (32)

1. Maragakis LL, Perencevich EN, Cosgrove SE: Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther 2008; 6:751-763
2. Miyakis S, Pefanis A, Tsakris A: The challenges of antimicrobial drug resistance in Greece. Clin Infect Dis 2011; 53:177-184
3. Shorr AF, Micek ST, Kollef MH: Inappropriate therapy for methicillin-resistant Staphylococcus aureus: Resource utilization and cost implications. Crit Care Med 2008; 36:2335-2340
4. Zilberberg MD, Kollef MH, Arnold H, et al: Inappropriate empiric antifungal therapy for candidemia in the ICU and hospital resource utilization: A retrospective cohort study. BMC Infect Dis 2010; 10:150
5. Shorr AF, Micek ST, Welch EC, et al: Inappropriate antibiotic therapy in Gram-negative sepsis increases hospital length of stay. Crit Care Med 2011; 39:46-51
6. Shorr AF, Micek ST, Jackson WL Jr, et al: Economic implications of an evidence-based sepsis protocol: Can we improve outcomes and lower costs? Crit Care Med 2007; 35:1257-1262
7. Kollef MH, Sherman G, Ward S, et al: Inadequate antimicrobial treatment of infections: A risk factor for hospital mortality among critically ill patients. Chest 1999; 115:462-474
8. Dhainaut JF, Laterre PF, LaRosa SP, et al: The clinical evaluation committee in a large multicenter phase 3 trial of drotrecogin alfa (activated) in patients with severe sepsis (PROWESS): Role, methodology, and results. Crit Care Med 2003; 31:2291-2301
9. Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, et al: Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 2003; 31:2742-2751
10. Harbarth S, Garbino J, Pugin J, et al: Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulat-ing therapy for severe sepsis. Am J Med 2003; 115:529-535
11. Ferrer R, Artigas A, Suarez D, et al; Edusepsis Study Group: Effectiveness of treatments for severe sepsis: A prospective, multicenter, observational study. Am J Respir Crit Care Med 2009; 180:861-866
12. Arias CA, Murray BE: Antibiotic-resistant bugs in the 21st century-A clinical super-challenge. N Engl J Med 2009; 360:439-443
13. Boucher HW, Talbot GH, Bradley JS, et al: Bad bugs, no drugs: No ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:1-12
14. Kollef MH: Broad-spectrum antimicrobials and the treatment of serious bacterial infections: Getting it right up front. Clin Infect Dis 2008; 47(Suppl 1):S3-13
15. Barochia AV, Cui X, Vitberg D, et al: Bundled care for septic shock: An analysis of clinical trials. Crit Care Med 2010; 38:668-678
16. Dellinger RP, Levy MM, Rhodes A, et al; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup: Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013; 41:580-637
17. Johnson MT, Reichley R, Hoppe-Bauer J, et al: Impact of previous antibiotic therapy on outcome of Gram-negative severe sepsis. Crit Care Med 2011; 39:1859-1865
18. Kollef MH: Ventilator-associated pneumonia. A multivariate analysis. JAMA 1993; 270:1965-1970
19. Magiorakos AP, Srinivasan A, Carey RB, et al: Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard defnitions for acquired resistance. Clin Microbiol Infect 2012; 18:268-281
20. Sawyer AM, Deal EN, Labelle AJ, et al: Implementation of a real-time computerized sepsis alert in nonintensive care unit patients. Crit Care Med 2011; 39:469-473
21. Bailey TC, Chen Y, Mao Y, et al: A trial of a real-time alert for clinical deterioration in patients hospitalized on general medical wards. J Hosp Med 2013; 8:236-242
22. Hussein K, Raz-Pasteur A, Finkelstein R, et al: Impact of carbape-nem resistance on the outcome of patients' hospital-acquired bacteremia caused by Klebsiella pneumoniae. J Hosp Infect 2013; 83:307-313
23. Madaras-Kelly KJ, Remington RE, Fan VS, et al: Predicting antibiotic resistance to community-acquired pneumonia antibiotics in culture-positive patients with healthcare-associated pneumonia. J Hosp Med 2012; 7:195-202
24. Kritsotakis EI, Tsioutis C, Roumbelaki M, et al: Antibiotic use and the riskof carbapenem-resistant extended-spectrum-{beta}-lactamase-producing Klebsiella pneumoniae infection in hospitalized patients: Results of a double case-control study. J Antimicrob Chemother 2011; 66:1383-1391
25. Seymann GB, Di Francesco L, Sharpe B, et al: The HCAP gap: Differences between self-reported practice patterns and published guidelines for health care-associated pneumonia. Clin Infect Dis 2009; 49:1868-1874
26. Kumar A, Roberts D, Wood KE, et al: Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34: 1589-1596
27. Shorr AF, Zilberberg MD, Reichley R, et al: Validation of a clinical score for assessing the risk of resistant pathogens in patients with pneumonia presenting to the emergency department. Clin Infect Dis 2012; 54:193-198
28. Hrabák J, Chudácková E, Walková R: Matrix-assisted laser desorption ionization-time of fight (MALDI-TOF) mass spectrometry for detection of antibiotic resistance mechanisms: From research to routine diagnosis. Clin Microbiol Rev 2013; 26:103-114
29. Andersson P, Tong SY, Bell JM, et al: Minim typing-a rapid and low cost MLST based typing tool for Klebsiella pneumoniae. PLoS One 2012; 7:e33530
30. Kho AN, Doebbeling BN, Cashy JP, et al: A regional informatics platform for coordinated antibiotic-resistant infection tracking, alerting, and prevention. Clin Infect Dis 2013; 57:254-262
31. Johnson AP: Improving antimicrobial stewardship: AmWeb, a tool for helping microbiologists in England to 'Start Smart' when advising on antibiotic treatment. J Antimicrob Chemother 2013; 68:2181-2182
32. Chalfne A, Cauet D, Lin WC, et al: Highly sensitive and effcient computer-assisted system for routine surveillance for surgical site infection. Infect Control Hosp Epidemiol 2006; 27:794-801