Healing soles: a microbiology-driven electronic health record-algorithm and order set to decrease antipseudomonal use
Antoinette Marie Acbo1, Naida Koura-Mola1, Terrence McSweeney1
1Department of Pharmacy, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Antimicrobial Stewardship & Healthcare Epidemiology : ASHE
|March 31, 2025
Summary
Electronic health record tools reduced antipseudomonal antibiotic use for diabetic foot infections (DFI). This intervention did not increase mortality or amputation rates, demonstrating improved DFI management.
Area of Science:
- Infectious Diseases
- Clinical Informatics
- Pharmacology
Background:
- Diabetic foot infections (DFI) often receive broad-spectrum antipseudomonal antibiotics despite low prevalence of *Pseudomonas aeruginosa*.
- A multidisciplinary team developed an electronic health record (EHR)-embedded treatment algorithm and order set to optimize antibiotic prescribing for DFI.
Purpose of the Study:
- To evaluate the impact of an EHR-embedded treatment algorithm and order set on antipseudomonal antibiotic use in patients with DFI.
- To assess secondary outcomes including length of stay, readmission rates, mortality, amputation, and *Clostridioides difficile* infection.
Main Methods:
- A multi-center, quasi-experimental study compared DFI patients pre- and post-implementation of the EHR intervention.
- Adult patients admitted for DFI on antibiotics were included; exclusion criteria applied.
- Primary endpoint was antipseudomonal antibiotic use (DOT/1000 DFI days present).
Main Results:
- Antipseudomonal use decreased significantly post-intervention (360 vs 503 DOT/1000 DFI days; P < 0.001).
- Empiric antipseudomonal use dropped from 85.7% to 72% (post-algorithm) and 68.5% (post-order set).
- 30-day mortality and amputation rates remained similar across groups.
Conclusions:
- EHR-embedded clinical decision support tools effectively reduce unnecessary antipseudomonal antibiotic prescribing for DFI.
- The intervention improved antibiotic stewardship without adversely affecting patient outcomes like mortality or amputation.
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