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JAC Advance Access published online on December 17, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn504
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Performance of the TREAT decision support system in an environment with a low prevalence of resistant pathogens

Kristian Kofoed1, Alina Zalounina2,*, Ove Andersen1, Gorm Lisby3, Mical Paul4,5, Leonard Leibovici4,5 and Steen Andreassen2

1 Clinical Research Centre and Department of Infectious Diseases, Copenhagen University Hospital, 2650 Hvidovre, Denmark 2 Center for Model-based Medical Decision Support, Aalborg University, 9220 Aalborg East, Denmark 3 Department of Clinical Microbiology, Copenhagen University Hospital, 2650 Hvidovre, Denmark 4 Department of Medicine E, Rabin Medical Center, Beilinson Campus, 49100 Petah-Tiqva, Israel 5 Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel

Received 29 June 2008; returned 29 August 2008; revised 11 October 2008; accepted 19 November 2008

* Corresponding author. Tel: +45-99408795; Fax: +45-98154008; E-mail: az{at}hst.aau.dk

Objectives: To evaluate a decision support system (TREAT) for guidance of empirical antimicrobial therapy in an environment with a low prevalence of resistant pathogens.

Methods: A retrospective trial of TREAT has been performed at Copenhagen University, Hvidovre Hospital. The cohort of patients included adults with systemic inflammation and suspicion of community-acquired bacterial infection. The empirical antimicrobial treatment recommended by TREAT was compared with the empirical antimicrobial treatment prescribed by the first attending clinical physician.

Results: Out of 171 patients recruited, 161 (65 with microbiologically documented infections) fulfilled the inclusion criteria of TREAT. Coverage achieved by TREAT was significantly higher than that by clinical practice (86% versus 66%, P = 0.007). There was no significant difference in the cost of future resistance between treatments chosen by TREAT and those by physicians. The direct expenses for antimicrobials were higher in TREAT when including patients without antimicrobial treatment, while there was no significant difference otherwise. The cost of side effects was significantly lower using TREAT.

Conclusions: The results of the study suggest that TREAT can improve the appropriateness of antimicrobial therapy and reduce the cost of side effects in regions with a low prevalence of resistant pathogens, however, at the expense of increased use of antibiotics.

Key Words: computerized decision support system , empirical antimicrobial therapy , severe infections


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