Evaluation of a Computerized Decision Support Intervention to Decrease Use of Anti-Pseudomonal Carbapenems in...

Area of Science:

• Infectious Diseases
• Clinical Pharmacy
• Health Informatics

Background:

• Beta-lactam antibiotic allergies are frequently reported but often lack true hypersensitivity.
• Cross-reactivity with advanced cephalosporins and carbapenems is low, especially in patients without type 1 hypersensitivity.
• Clinicians often overprescribe antipseudomonal carbapenems (APC) for patients with beta-lactam allergy history, even in low-risk scenarios.

Purpose of the Study:

• To evaluate the impact of a computerized decision support system (CDSS) intervention on APC prescribing patterns.
• To assess if the CDSS improved the selection of appropriate antibiotics for patients with beta-lactam allergy history.
• To determine if the intervention reduced APC use, particularly in low-risk patients.

Main Methods:

• A retrospective evaluation was conducted in a hospital setting.
• Computerized decision support system (CDSS) changes were implemented to guide beta-lactam cross-reactivity risk assessment and therapy selection.
• Antipseudomonal carbapenem (APC) initiations were measured per 1000 patient-days before and after the intervention.
• Interrupted time-series analysis was used to assess changes in APC prescribing trends.

Main Results:

• Aggregate monthly APC initiations decreased significantly from 7.01 to 6.14 per 1000 patient-days post-intervention (p = 0.03).
• APC initiations for low-risk beta-lactam history patients decreased from 92% to 83% (p = 0.17), though not statistically significant.
• No adverse events were observed in patients with low-risk beta-lactam histories during the study period.

Conclusions:

• The CDSS intervention was associated with a reduction in overall APC initiations.
• The findings suggest that CDSS can effectively guide clinicians towards more appropriate antibiotic selection in beta-lactam allergy cases.
• Further studies may be needed to confirm the impact on low-risk patient prescribing and to assess long-term effects.