さまよう薬剤師のブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense a ID pharmacist. Another face is an investor.

A clinical decision support system algorithm for intravenous to oral antibiotic switch therapy: validity, clinical relevance and usefulness in a three-step evaluation study

JACに報告された、antibio switch tx サポートシステム。

academic.oup.com

 

感想

antibio switch tx は、AIで対応できる可能性を示している。

De-escalationも対応できると思いますし、

我々は、さらなる付加価値を考えていかないと、、、

 

note

  • CDSS
  • positive predictive value of 76.6%
  • negative predictive value of 99.1%
  • 53.5% - 43.4% = 10.1%

Abstract

Objectives

To evaluate a clinical decision support system (CDSS) based on consensus-based intravenous to oral switch criteria, which identifies intravenous to oral switch candidates.

Methods

A three-step evaluation study of a stand-alone CDSS with electronic health record interoperability was performed at the Erasmus University Medical Centre in the Netherlands. During the first step, we performed a technical validation. During the second step, we determined the sensitivity, specificity, negative predictive value and positive predictive value in a retrospective cohort of all hospitalized adult patients starting at least one therapeutic antibacterial drug between 1 and 16 May 2013. ICU, paediatric and psychiatric wards were excluded. During the last step the clinical relevance and usefulness was prospectively assessed by reports to infectious disease specialists. An alert was considered clinically relevant if antibiotics could be discontinued or switched to oral therapy at the time of the alert.

Results

During the first step, one technical error was found. The second step yielded a positive predictive value of 76.6% and a negative predictive value of 99.1%. The third step showed that alerts were clinically relevant in 53.5% of patients. For 43.4% it had already been decided to discontinue or switch the intravenous antibiotics by the treating physician. In 10.1%, the alert resulted in advice to change antibiotic policy and was considered useful.

Conclusions

This prospective cohort study shows that the alerts were clinically relevant in >50% (n =449) and useful in 10% (n =85). The CDSS needs to be evaluated in hospitals with varying activity of infectious disease consultancy services as this probably influences usefulness.

 

f:id:akinohanayuki:20180809060657p:plain

 

9 AkhloufiH,HulscherM,MellesDCetal.Developmentofoperationalized intravenous to oral antibiotic switch criteria. J Antimicrob Chemother2017; 72: 543–6.