Clinical decision support system to guide antimicrobial selection: a narrative review from 2019 to 2023

Area of Science:

• Health Informatics
• Infectious Disease Management
• Pharmacology

Background:

• Clinical Decision Support Systems (CDSS) are increasingly vital for enhancing healthcare delivery.
• Antimicrobial stewardship is a critical area for improving patient outcomes and combating resistance.

Purpose of the Study:

• To conduct a narrative review of CDSS for antimicrobial prescribing.
• To identify and describe CDSS developed between 2019 and 2023.
• To analyze the goals, clinical impact, and evaluation characteristics of these systems.

Main Methods:

• Searched MEDLINE for original research on CDSS for antimicrobial selection (antibiotics, antivirals, antifungals, antiparasitics).
• Extracted data on CDSS goals, potential clinical impacts, and study evaluation characteristics.
• Included studies describing CDSS evaluation in various settings and populations.

Main Results:

• 28 studies were included, with most (n=24) focusing on antibiotics.
• 15 CDSS were integrated into electronic health records; only one originated from a low- and middle-income country (LMIC).
• Most CDSS aimed to aid antimicrobial selection, with few reporting no impact on antibiotic use or guideline compliance.

Conclusions:

• CDSS for antimicrobial prescribing is a growing field with potential to optimize antimicrobial use.
• Clinical evaluation of CDSS is essential before implementation.
• Efforts are needed to improve CDSS transferability, adoption (especially in LMICs), and user awareness through education.