Observational studyBMJ open2014
Long-term effect of computer-assisted decision support for antibiotic treatment in critically ill patients: a prospective 'before/after' cohort study.
Observational study in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 4 syntheses or guidelines pooled it, 70 citations in OpenAlex.
- Pooled it
- Linking antimicrobial resistance surveillance to antibiotic policy in healthcare settings: the COMBACTE-Magnet EPI-Net COACH project.The Journal of antimicrobial chemotherapy · 2020Pooled it
- Effect of Electronic Prescribing Strategies on Medication Error and Harm in Hospital: a Systematic Review and Meta-analysis.Journal of general internal medicine · 2019Pooled it
- The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review.PloS one · 2017Pooled it
- Effect of a Feedback Visit and a Clinical Decision Support System Based on Antibiotic Prescription Audit in Primary Care: Multiarm Cluster-Randomized Controlled Trial.Journal of medical Internet research · 2024Trial
- Seventeen Years of an Antibiotic Stewardship Programme: Trends in Antibiotic Prescribing and Gram-Negative Bacilli Susceptibility at a Quaternary Healthcare Institution.Antibiotics (Basel, Switzerland) · 2025Article
- Bug Wars: Artificial Intelligence Strikes Back in Sepsis Management.Diagnostics (Basel, Switzerland) · 2025Review
- The Digital Transformation of Healthcare Through Intelligent Technologies: A Path Dependence-Augmented-Unified Theory of Acceptance and Use of Technology Model for Clinical Decision Support Systems.Healthcare (Basel, Switzerland) · 2025Article
- Compliance with antibiotic therapy guidelines in french paediatric intensive care units: a multicentre observational study.BMC infectious diseases · 2024Observational
- Microbiological profile of patients treated for postoperative peritonitis: temporal trends 1999-2019.World journal of emergency surgery : WJES · 2023Article
- Long-Term Impact of a Smartphone App on Prescriber Adherence to Antibiotic Guidelines for Adult Patients With Community-Acquired Pneumonia: Interrupted Time-Series Study.Journal of medical Internet research · 2023Article
- Evaluation of Clinical Outcomes After Introduction of a Dedicated Infectious Diseases-Critical Care Medicine Service in Critical Care Units.Open forum infectious diseases · 2021Article
- Article
- [Computer-assisted decision-making for trauma patients].Der Unfallchirurg · 2020Review
- Leeds-Genoa Non-Union Index: a clinical tool for asessing the need for early intervention after long bone fracture fixation.International orthopaedics · 2020Article
- An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes.Journal of pharmaceutical policy and practice · 2020Article
- Improving Adherence to Practice Guidelines for Anticoagulation in Patients Receiving Neuraxial Anesthesia Using an Electronic Order Entry Alert System.Journal of patient safety · 2019Article
- Clinical Decision Support Systems and Their Role in Antibiotic Stewardship: a Systematic Review.Current infectious disease reports · 2019Article
- Article
- [Antibiotic stewardship in a basic care hospital : A retrospective observational study].Der Anaesthesist · 2018Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesAntibiotic resistance has risen dramatically over the past years. For individual patients, adequate initial antibiotic therapy is essential for clinical outcome. Computer-assisted decision support systems (CDSSs) are advocated to support implementation of rational anti-infective treatment strategies based on guidelines. The aim of this study was to evaluate long-term effects after implementation of a CDSS.
designThis prospective 'before/after' cohort study was conducted over four observation periods within 5 years. One preinterventional period (pre) was compared with three postinterventional periods: directly after intensive implementation efforts (post1), 2 years (post2) and 3 years (post3) after implementation.
settingFive anaesthesiological-managed intensive care units (ICU) (one cardiosurgical, one neurosurgical, two interdisciplinary and one intermediate care) at a university hospital.
participantsAdult patients with an ICU stay of >48 h were included in the analysis. 1316 patients were included in the analysis for a total of 12,965 ICU days.
interventionImplementation of a CDSS. OUTCOME MEASURES: The primary end point was percentage of days with guideline adherence during ICU treatment. Secondary end points were antibiotic-free days and all-cause mortality compared for patients with low versus high guideline adherence. MAIN
resultsAdherence to guidelines increased from 61% prior to implementation to 92% in post1, decreased in post2 to 76% and remained significantly higher compared with baseline in post3, with 71% (p=0.178). Additionally, antibiotic-free days increased over study periods. At all time periods, mortality for patients with low guideline adherence was higher with 12.3% versus 8% (p=0.014) and an adjusted OR of 1.56 (95% CI 1.05 to 2.31).
conclusionsImplementation of computerised regional adapted guidelines for antibiotic therapy is paralleled with improved adherence. Even without further measures, adherence stayed high for a longer period and was paralleled by reduced antibiotic exposure. Improved guideline adherence was associated with reduced ICU mortality. TRIAL REGISTRATION NUMBER: ISRCTN54598675.
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