Skip to main content
    • Aa
    • Aa

Use of a Computer Decision Support System and Antimicrobial Therapy Appropriateness

  • Gregory A. Filice (a1) (a2), Dimitri M. Drekonja (a1) (a2), Joseph R. Thurn (a1) (a2), Thomas S. Rector (a3), Galen M. Hamann (a1), Bobbie T. Masoud (a1), Anne-Marie Leuck (a2), Curtis L. Nordgaard (a4), Meredith K. Eilertson (a5) and James R. Johnson (a1) (a2)...

To determine whether antimicrobial (AM) courses ordered with an antimicrobial computer decision support system (CDSS) were more likely to be appropriate than courses ordered without the CDSS.


Retrospective cohort study. Blinded expert reviewers judged whether AM courses were appropriate, considering drug selection, route, dose, and duration.


A 279-bed university-affiliated Department of Veterans Affairs (VA) hospital.


A 500-patient random sample of inpatients who received a therapeutic AM course between October 2007 and September 2008.


An optional CDSS, available at the point of order entry in the VA computerized patient record system.


CDSS courses were significantly more likely to be appropriate (111/254, 44%) compared with non-CDSS courses (81/246, 33%, P = .013). Courses were more likely to be appropriate when the initial provider diagnosis of the condition being treated was correct (168/273, 62%) than when it was incorrect, uncertain, or a sign or symptom rather than a disease (24/227, 11%, P< .001). In multivariable analysis, CDSS-ordered courses were more likely to be appropriate than non-CDSS-ordered courses (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.13–2.98). Courses were also more likely to be judged appropriate when the initial provider diagnosis of the condition being treated was correct than when it was incorrect, uncertain, or a sign or symptom rather than a disease (OR, 3.56; 95% CI, 1.4-9.0).


Use of the CDSS was associated with more appropriate AM use. To achieve greater improvements, strategies are needed to improve provider diagnoses of syndromes that are infectious or possibly infectious.

Corresponding author
Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Minneapolis, MN 55417 (
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

2. JG Bartlett . A call to arms: the imperative for antimicrobial stewardship. Clin Infect Dis 2011;53(Suppl 1):S4S7.

5. HW Boucher , GH Talbot , JS Bradley , et al.Bad bugs, no drugs: no ESKAPE! an update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48:112.

6. TH Dellit , RC Owens , JE McGowan , et al.Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159177.

7. ST Micek , EC Welch , J Khan , et al.Empiric combination antibiotic therapy is associated with improved outcome against sepsis due to gram-negative bacteria: a retrospective analysis. Antimicrob Agents Chemother 2010;54:17421748.

8. MH Kollef , G Sherman , S Ward , VJ Fraser . Inadequate anti-microbial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999;115:462474.

9. DC Classen , SL Pestotnik , RS Evans , JP Burke . Computerized surveillance of adverse drug events in hospital patients. JAMA 1991;266:28472851.

10. N Shehab , PR Patel , A Srinivasan , DS Budnitz . Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis 2008;47:735743.

11. CA Ohl , VP Luther . Antimicrobial stewardship for inpatient facilities. J Hosp Med 2011;6(Suppl 1):S4S15.

12. MT Hecker , DC Aron , NP Patel , MK Lehmann , CJ Donskey . Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163:972978.

13. TM File Jr JS Solomkin , SE Cosgrove . Strategies for improving antimicrobial use and the role of antimicrobial stewardship programs. Clin Infect Dis 2011;53(Suppl 1):S15S22.

14. P Davey , E Brown , L Fenelon , et al.Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2005;(4):CD003543.

15. K Thursky . Use of computerized decision support systems to improve antibiotic prescribing. Expert Rev Anti Infect Ther 2006;4:491507.

16. SL Pestotnik , DC Classen , RS Evans , JP Burke . Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med 1996;124:884890.

17. JA Welker , M Huston , JD McCue . Antibiotic timing and errors in diagnosing pneumonia. Arch Intern Med 2008;168:351356.

18. BA Nicks , DE Manthey , MT Fitch . The Centers for Medicare and Medicaid Services (CMS) community-acquired pneumonia core measures lead to unnecessary antibiotic administration by emergency physicians. Acad Emerg Med 2009;16:184187.

19. ME Charlson , P Pompei , KL Ales , CR MacKenzie . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373383.

23. J Avorn , DH Solomon . Cultural and economic factors that (mis)shape antibiotic use: the nonpharmacologic basis of therapeutics. Ann Intern Med 2000;133:128135.

24. RS Evans , DC Classen , SL Pestotnik , HP Lundsgaarde , JP Burke . Improving empiric antibiotic selection using computer decision support. Arch Intern Med 1994;154:878884.

25. JF Westphal , F Jehl , H Javelot , C Nonnenmacher . Enhanced physician adherence to antibiotic use guidelines through increased availability of guidelines at the time of drug ordering in hospital setting. Pharmacoepidemiol Drug Saf 2011;20:162168.

26. MH Samore , K Bateman , SC Alder , et al.Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial. JAMA 2005;294:23052314.

27. TJ Bright , A Wong , R Dhurjati , et al.Effect of clinical decision-support systems: a systematic review. Ann Intern Med 2012;157:2943.

29. JC McGregor , E Weekes , GN Forrest , et al.Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial. J Am Med Inform Assoc 2006;13:378384.

30. V Sintchenko , E Coiera , GL Gilbert . Decision support systems for antibiotic prescribing. Curr Opin Infect Dis 2008;21:573579.

31. KA Thursky , KL Buising , N Bak , et al.Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit. Int J Qual Health Care 2006;18:224231.

32. R Kaki , M Elligsen , S Walker , A Simor , L Palmay , N Daneman . Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother 2011;66:12231230.

33. E Charani , J Cooke , A Holmes . Antibiotic stewardship programmes: what's missing? J Antimicrob Chemother 2010;65:22752277.

34. DC Classen , DW Bates . Finding the meaning in meaningful use. N Engl J Med 2011;365:855858.

35. JA Osheroff , JM Teich , B Middleton , EB Steen , A Wright , DE Detmer . A roadmap for national action on clinical decision support. J Am Med Inform Assoc 2007;14:141145.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 16 *
Loading metrics...

Abstract views

Total abstract views: 115 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th May 2017. This data will be updated every 24 hours.