Clinical Trial: Computerized Decision Support System for Antibiotic Treatment

Study Status: Completed
Recruit Status: Completed
Study Type: Interventional

Official Title: Improving Empirical Antibiotic Treatment Using TREAT,a Computerized Decision Support System. Cluster Randomized Trial

Brief 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.

Detailed Summary:

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 of
Sponsor: Rabin Medical Center

Current Primary Outcome: Appropriate antibiotic treatment

Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Overall 30-day mortality
  • Durations of fever
  • Duration of hospital stay
  • Antibiotic use
  • Antibiotic costs
  • Adverse events


Original Secondary Outcome: Same as current

Information By: Rabin Medical Center

Dates:
Date Received: October 4, 2005
Date Started: May 2004
Date Completion: November 2004
Last Updated: July 17, 2006
Last Verified: October 2005