Impact of an integrated electronic Clinical Decision Support System with proactive Antimicrobial Stewardship Feedback...

To assess whether an electronic Clinical Decision Support System (eCDSS), embedded within a hospital-wide antimicrobial stewardship (AMS) programme, can meaningfully reduce antimicrobial use and improve prescribing quality in routine clinical practice.

We conducted a prospective quasi-experimental interrupted time-series study in a 1200-bed tertiary-care hospital in Italy (April 2022-April 2024). The eCDSS, integrated into computerized order entry and linked to pharmacy data, triggered real-time identification of high-impact antimicrobial prescriptions and enabled infectious diseases (IDs)-led prospective audit and feedback. Primary outcomes were overall antibiotic use and carbapenem consumption; secondary outcomes included guideline adherence, stewardship intensity, antimicrobial duration and costs.

Across 5890 prescriptions in 2604 patients (9336 ID evaluations), the intervention was associated with a significant and sustained reduction in overall antibiotic consumption (CL: -3.27 DDD/100 patient-days, 95% CI -6.06 to -0.47; CT: -0.25 DDD/100 patient-days/month, 95% CI -0.44 to -0.07). Carbapenem use showed a parallel significant decline across both DDD and DOT metrics. In contrast, no significant reductions were observed for other monitored antibiotics or antifungals. Prescribing quality improved over time, with increasing adherence to local guidelines (CT: +1.59%/month; P = 0.001). Despite high-intensity stewardship activity (mean 1.6 ID interventions per prescription), antimicrobial expenditures remained stable, although a downward trend was observed.

An eCDSS integrated into a human-led AMS programme was associated with a significant reduction in overall antibiotic and carbapenem use and improved prescribing quality. These findings demonstrate that digital stewardship tools do not replace but amplify ID expertise and pharmacy collaboration, enabling sustained optimization of antimicrobial use.