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

Christina Caplinger1, Garret Smith2, Richard Remington3

  • 1Infectious Diseases Research Fellow, Pharmacy Service, Boise Veterans Affairs Medical Center, Bldg T111, 500 W Fort St. Boise, ID 83702, USA. Christina.caplinger@va.gov.

Antibiotics (Basel, Switzerland)
|March 31, 2016
PubMed

Insights

A computerized decision support system (CDSS) intervention reduced the prescribing of antipseudomonal carbapenems (APC) in patients with beta-lactam allergy history. This change improved appropriate antibiotic selection without adverse events, demonstrating effective clinical decision support.

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.
Keywords:
antimicrobial stewardshipantipseudomonalcarbapenemcomputerized decision support systemβ-lactam allergyβ-lactam cross-reactivity

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