Antibiotic use and microbial resistance in intensive care units: Impact ofcomputer-assisted decision support

As part of our integrated hospital information system (the HELP system), we developed computer-assisted decision support programs for antimicrobial pr escribing that are available at bedside terminals throughout our 520-bed co mmunity hospital. Recently, options have been added to allow direct physici an order entry of anti-infective agents in the shock-trauma intensive care unit (STRICU). Physicians prescribed the computer-suggested regimens for 46 % but followed the suggested dose and interval for 93% of the orders during a 1-year study period. In comparison to a 2-year pre-intervention period, improved drug selection and reductions in adverse drug events and costs wer e seen. Antimicrobial resistance patterns for nosocomial Gram-negative isol ates remained stable or improved in the STRICU over an Ii-year period of co mputer-assisted antibiotic management. We conclude that strategies for opti mizing antimicrobial prescribing have the potential to stabilize resistance and reduce costs by encouraging heterogeneous prescribing patterns, use of local antimicrobial susceptibility patterns to inform empiric drug selecti on, and reduced "tonnage" of antibiotic use.