Computer-assisted decision support systems (CDSS) are designed to improve infection management. The aim of this prospective, clinical pre- and post-intervention study was to investigate the influence of CDSS on infection management of severe sepsis and septic shock in intensive care units (ICUs). Data were collected for a total of 180 days during two study periods in 2006 and 2007. Of the 186 patients with severe sepsis or septic shock, 62 were stratified into a low adherence to infection management standards group (LAG) and 124 were stratified into a high adherence group (HAG). ICU mortality was significantly increased in LAG versus HAG patients (Kaplan–Meier analysis). Following CDSS implementation, adherence to standards increased significantly by 35%, paralleled with improved diagnostics, more antibiotic-free days and a shortened time until antibiotics were administered. In conclusion, adherence to infection standards is beneficial for patients with severe sepsis or septic shock and CDSS is a useful tool to aid adherence.
VincentJLTacconeFSchmitX: Classification, incidence, and outcomes of sepsis and multiple organ failure. Contrib Nephrol2007; 156: 64–74.
2.
DellingerRPLevyMMCarletJM: Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med2008; 34: 17–60.
3.
DellingerRPCarletJMMasurH: Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med2004; 32: 858–873.
4.
FerrerRAArtigasALevyMM: Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA2008; 299: 2294–2303.
5.
FerrerRArtigasASuarezD: Effectiveness of treatments for severe sepsis: A prospective, multicenter, observational study. Am J Respir Crit Care Med2009; 180: 861–866.
6.
DaveyPBrownEFenelonL: Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev2005; 19: CD003543.
7.
KumarARobertsDWoodKE: Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med2006; 34: 1589–1596.
8.
PaganiLGyssensICHuttnerB: Navigating the Web in search of resources on antimicrobial stewardship in health care institutions. Clin Infect Dis2009; 48: 626–632.
9.
DejaMNachtigallIHalleE: Strategies in the treatment of infections with antibiotics in intensive care medicine. Anasthesiol Intensivmed Notfallmed Schmerzther2007; 42: 108–115 [in German, English abstract].
10.
NachtigallIDejaMHalleE: Implementation of standard operating procedures for the initial empirical antimicrobial therapy for adults–a new computer program at the University Hospital Charité. Anasthesiol Intensivmed Notfallmed Schmerzther2006; 41: 626–635 [in German, English abstract].
11.
WearsRLBergM: Computer technology and clinical work: Still waiting for Godot. JAMA2005; 293: 1261–1263.
12.
MorrisAH: Rational use of computerized protocols in the intensive care unit. Crit Care2001; 5: 249–254.
13.
SchurinkCALucasPJHoepelmanIM: Computer-assisted decision support for the diagnosis and treatment of infectious diseases in intensive care units. Lancet Infect Dis2005; 5: 305–312.
14.
GargAXAdhikariNKMcDonaldH: Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: A systematic review. JAMA2005; 293: 1223–1238.
15.
SamoreMHBatemanKAlderSC: Clinical decision support and appropriateness of antimicrobial prescribing: A randomized trial. JAMA2005; 294: 2305–2314.
16.
BuisingKLThurskyKABlackJF: Improving antibiotic prescribing for adults with community acquired pneumonia: Does a computerised decision support system achieve more than academic detailing alone? A time series analysis. BMC Med Inform Decis Mak2008; 8: 35.
17.
EvansRSPestotnikSLClassenDC: A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med1998; 338: 232–238.
18.
GarnerJSJarvisWREmoriTG: CDC definitions for nosocomial infections, 1988. Am J Infect Control1988; 16: 128–140.
19.
NachtigallIDejaMTafelskiS: Adherence to standard operating procedures is crucial for intensive care unit survival of elderly patients. J Int Med Res2008; 36: 438–459.
20.
NachtigallITamarkinATafelskiS: Impact of adherence to standard operating procedures for pneumonia on outcome of intensive care unit patients. Crit Care Med2009; 37: 159–166.
21.
VincentJLMorenoR: Clinical review: Scoring systems in the critically ill. Crit Care2010; 14: 207.
22.
AngusDCLinde-ZwirbleWTLidickerJ: Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med2001; 29: 1303–1310.
23.
Brun-BuissonCDoyonFCarletJ: Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA1995; 274: 968–974.
24.
BlancoJMuriel-BombínASagredoV: Incidence, organ dysfunction and mortality in severe sepsis: A Spanish multicentre study. Crit Care2008; 12: R158.
25.
RiversEPKruseJAJacobsenG: The influence of early hemodynamic optimization on biomarker patterns of severe sepsis and septic shock. Crit Care Med2007; 35: 2016–2024.
26.
ShapiroNIHowellMDTalmorD: Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol. Crit Care Med2006; 34: 1025–1032.
27.
McGregorJCWeekesEForrestGN: Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: A randomized controlled trial. J Am Med Inform Assoc2006; 13: 378–384.
28.
HeckerlingPSGerberBSTapeTG: Prediction of community-acquired pneumonia using artificial neural networks. Med Decis Making2003; 23: 112–121.
29.
GeorgePMorrisAM: Pro/con debate: Should antimicrobial stewardship programs be adopted universally in the intensive care unit?Crit Care2010; 14: 205.
30.
SintchenkoVIredellJRGilbertGL: Handheld computer-based decision support reduces patient length of stay and antibiotic prescribing in critical care. J Am Med Inform Assoc2005; 12: 398–402.
