Table 3.
Appropriateness of Antibiotic Use, Acceptance of Recommendations, and Outcomes of Patients who Received Broad-Spectrum Antibiotics Guided by Voluntary or Compulsory CDSS and PRF Recommendations
| Characteristics | Voluntary CDSS (n = 641) | Compulsory CDSS (n = 616) | P |
|---|---|---|---|
| Reviewed by PRF | 448 (70) | 443 (72) | .43 |
| Appropriate indication under PRF reviews | 351/448 (78) | 330/443 (75) | .18 |
| Appropriate dose | 625 (98) | 599 (97) | .77 |
| Appropriate duration | 587 (92) | 548 (89) | .12 |
| Recommendations | |||
| Received CDSS recommendations | 132 (21) | 612 (99) | <.01 |
| Accepted CDSS recommendationsa | 130 (20) | 556 (90) | <.01 |
| Received PRF recommendations | 62 (10) | 81 (13) | .05 |
| Accepted PRF recommendationsa | 51 (8) | 71 (12) | .03 |
| Outcomes | |||
| 30-d mortality | 123 (19) | 102 (16) | .22 |
| 30-d re-infection rate | 132 (21) | 142 (23) | .29 |
| 30-d re-admission rate | 92 (14) | 87 (14) | .91 |
| Clinical response at day 7 | 535 (83) | 517 (84) | .82 |
| Length of stay, median (IQR), d | 15 (5–64) | 15 (4–70) | .92 |
| 6-mo multidrug-resistant organismsb | 152 (24) | 171 (27) | .10 |
| Diarrhea this admission | 89 (14) | 86 (14) | .96 |
| Index antibiotic days of therapy, median (IQR) | 4 (3–5) | 4 (3–5) | .47 |
| Index antibiotic days of therapy ≤3 | 295 (46) | 297 (48) | .45 |
| Gross hospitalization costs, median (IQR), S$ | 13 301 (7184–24 079) | 13 308 (6743–24 904) | .96 |
Data are presented as No. (%), unless otherwise indicated.
Abbreviations: CDSS, computerized decision support system; IQR, interquartile range; PRF, prospective review and feedback.
aPatients were considered to have recommendations by CDSS or PRF accepted if at least 1 of the recommendations provided by the respective service was accepted.
bMultidrug-resistant organisms were defined as methicillin-resistant S. aureus, vancomycin-resistant enterococci, third-generation cephalosporin or carbapenem-resistant Enterobacterales, and multidrug-resistant A. baumanii or P. aeruginosa and Clostridiodes difficile diarrhea. Data are for the intention-to-treat population.