Table 4.
Effect of intervention on qualitative antimicrobial outcomes, clinical outcomes, and microbiological outcomes
| Control* | Computerised decision-support system* | Total* | OR† | 95% CI | |
|---|---|---|---|---|---|
| Qualitative antimicrobial outcomes | |||||
| Appropriate choice of the molecule‡ | 337/455 (74·1%) | 370/503 (73·6%) | 707 (73·8%) | 1·03 | 0·71–1·49 |
| Appropriate duration | 356/430 (82·8%) | 389/460 (84·6%) | 745 (83·7%) | 1·12 | 0·78–1·60 |
| De-escalation done whenever possible | 90/115 (78·3%) | 98/121 (81·0%) | 188 (79·7%) | 1·05 | 0·53–2·05 |
| Oral switch by day 7 | 154/201 (76·6%) | 187/215 (87·0%) | 341 (82·0%) | 1·91 | 1·12–3·26 |
| Treatment adapted to microbiological results | 203/228 (89·0%) | 228/245 (93·1%) | 431 (91·1%) | 1·60 | 0·83–3·07 |
| Clinical outcomes | |||||
| 30-day in-hospital mortality | 368/6142 (6·0%) | 444/7808 (5·7%) | 812 (5·9%) | 1·02 | 0·86–1·21 |
| Readmission within 18 days | 413/7276 (5·7%) | 448/8680 (5·2%) | 861/15 956 (5·4%) | 0·90 | 0·74–1·09 |
| Transfer to ICU or to IMC | 284/9619 (3·0%) | 370/11 269 (3·3%) | 654 (2·7%) | 1·20 | 0·80–1·79 |
| Infectious disease consultation§ | 405/2390 (16·9%) | 388/2889 (13·4%) | 793 (15·0%) | 0·86 | 0·59–1·25 |
| Length of stay in the ward, median¶ | 7 | 6 | 6 | 0·95 | 0·84–1·08 |
| Microbiological outcomes | |||||
| Facility onset of Clostridioides difficile infection per 1000 admissions | 2 | 2·8 | 2·2 | 1·17 | 0·81–1·68 |
Length of stay shows the results of all available data. ICU=intensive care unit. IMC=intermediate care unit.
*
Denominators vary by outcomes.
†
Adjusted.
‡
Assessed only indications for which local guidelines are available.
§
Geneva only, the denominator is admissions receiving antimicrobials.
¶
For the analysis, 0·5 days was added to length of stay and then log transformed. A linear mixed-effect model was used. Endpoint was log (length of stay plus 0·5). Estimate was then a ratio of geometric means.