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Mortality Benefits of Antibiotic Computerised Decision Support System: Modifying Effects of Age.

Chow AL, Lye DC, Arah OA - Sci Rep (2015)

Bottom Line: No increase in infection-related readmission (OR 1.16, 95% CI 0.48-2.79) was found in survivors.Receipt of CDSS-recommended antibiotics reduced mortality risk in patients aged 65 years or younger and did not increase the risk in older patients.Physicians should be informed of the benefits to increase their acceptance of CDSS recommendations.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore.

ABSTRACT
Antibiotic computerised decision support systems (CDSSs) are shown to improve antibiotic prescribing, but evidence of beneficial patient outcomes is limited. We conducted a prospective cohort study in a 1500-bed tertiary-care hospital in Singapore, to evaluate the effectiveness of the hospital's antibiotic CDSS on patients' clinical outcomes, and the modification of these effects by patient factors. To account for clustering, we used multilevel logistic regression models. One-quarter of 1886 eligible inpatients received CDSS-recommended antibiotics. Receipt of antibiotics according to CDSS's recommendations seemed to halve mortality risk of patients (OR 0.54, 95% CI 0.26-1.10, P = 0.09). Patients aged ≤65 years had greater mortality benefit (OR 0.45, 95% CI 0.20-1.00, P = 0.05) than patients that were older than 65 (OR 1.28, 95% CI 0.91-1.82, P = 0.16). No effect was observed on incidence of Clostridium difficile (OR 1.02, 95% CI 0.34-3.01), and multidrug-resistant organism (OR 1.06, 95% CI 0.42-2.71) infections. No increase in infection-related readmission (OR 1.16, 95% CI 0.48-2.79) was found in survivors. Receipt of CDSS-recommended antibiotics reduced mortality risk in patients aged 65 years or younger and did not increase the risk in older patients. Physicians should be informed of the benefits to increase their acceptance of CDSS recommendations.

No MeSH data available.


Related in: MedlinePlus

Joint effects of age and receipt of ARUSC recommendations on 30-day all-cause mortality risk.
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f1: Joint effects of age and receipt of ARUSC recommendations on 30-day all-cause mortality risk.

Mentions: After adjusting for potential confounding, the receipt of antibiotics according to ARUSC’s recommendations halved the mortality risk of patients (OR 0.54, 95% CI 0.26–1.10, P = 0.09) (Table 3). In patients aged 65 and below, the receipt of antibiotics according to ARUSC’s recommendations reduced mortality by 55% (OR 0.45, 95% CI 0.20–1.00, P = 0.05). It did not have an effect on mortality in older patients >65 years old (OR 1.28, 95% CI 0.91–1.82, P = 0.16) (Table 4). Our study suggests that age (<=65 years) modified the effect of receipt of antibiotics according to ARUSC’s recommendations in reducing mortality risk; as such, the combined effect of age and receipt of antibiotics according to ARUSC’s recommendations was larger than the combination of their component effects (OR 0.37, 95% CI 0.18–0.72, P = 0.004) (Fig. 1). Effect estimates for age, receipt of antibiotics according to ARUSC’s recommendations, and interactions did not change notably when we restricted our population to patients who had been hospitalised <= 7 days (data not shown).


Mortality Benefits of Antibiotic Computerised Decision Support System: Modifying Effects of Age.

Chow AL, Lye DC, Arah OA - Sci Rep (2015)

Joint effects of age and receipt of ARUSC recommendations on 30-day all-cause mortality risk.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663624&req=5

f1: Joint effects of age and receipt of ARUSC recommendations on 30-day all-cause mortality risk.
Mentions: After adjusting for potential confounding, the receipt of antibiotics according to ARUSC’s recommendations halved the mortality risk of patients (OR 0.54, 95% CI 0.26–1.10, P = 0.09) (Table 3). In patients aged 65 and below, the receipt of antibiotics according to ARUSC’s recommendations reduced mortality by 55% (OR 0.45, 95% CI 0.20–1.00, P = 0.05). It did not have an effect on mortality in older patients >65 years old (OR 1.28, 95% CI 0.91–1.82, P = 0.16) (Table 4). Our study suggests that age (<=65 years) modified the effect of receipt of antibiotics according to ARUSC’s recommendations in reducing mortality risk; as such, the combined effect of age and receipt of antibiotics according to ARUSC’s recommendations was larger than the combination of their component effects (OR 0.37, 95% CI 0.18–0.72, P = 0.004) (Fig. 1). Effect estimates for age, receipt of antibiotics according to ARUSC’s recommendations, and interactions did not change notably when we restricted our population to patients who had been hospitalised <= 7 days (data not shown).

Bottom Line: No increase in infection-related readmission (OR 1.16, 95% CI 0.48-2.79) was found in survivors.Receipt of CDSS-recommended antibiotics reduced mortality risk in patients aged 65 years or younger and did not increase the risk in older patients.Physicians should be informed of the benefits to increase their acceptance of CDSS recommendations.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore.

ABSTRACT
Antibiotic computerised decision support systems (CDSSs) are shown to improve antibiotic prescribing, but evidence of beneficial patient outcomes is limited. We conducted a prospective cohort study in a 1500-bed tertiary-care hospital in Singapore, to evaluate the effectiveness of the hospital's antibiotic CDSS on patients' clinical outcomes, and the modification of these effects by patient factors. To account for clustering, we used multilevel logistic regression models. One-quarter of 1886 eligible inpatients received CDSS-recommended antibiotics. Receipt of antibiotics according to CDSS's recommendations seemed to halve mortality risk of patients (OR 0.54, 95% CI 0.26-1.10, P = 0.09). Patients aged ≤65 years had greater mortality benefit (OR 0.45, 95% CI 0.20-1.00, P = 0.05) than patients that were older than 65 (OR 1.28, 95% CI 0.91-1.82, P = 0.16). No effect was observed on incidence of Clostridium difficile (OR 1.02, 95% CI 0.34-3.01), and multidrug-resistant organism (OR 1.06, 95% CI 0.42-2.71) infections. No increase in infection-related readmission (OR 1.16, 95% CI 0.48-2.79) was found in survivors. Receipt of CDSS-recommended antibiotics reduced mortality risk in patients aged 65 years or younger and did not increase the risk in older patients. Physicians should be informed of the benefits to increase their acceptance of CDSS recommendations.

No MeSH data available.


Related in: MedlinePlus