Objectives Antibiotic resistance has risen dramatically over the past years.
For individual patients, adequate initial antibiotic therapy is essential for
clinical outcome. Computer-assisted decision support systems (CDSSs) are
advocated to support implementation of rational anti-infective treatment
strategies based on guidelines. The aim of this study was to evaluate long-
term effects after implementation of a CDSS. Design This prospective
‘before/after’ cohort study was conducted over four observation periods within
5 years. One preinterventional period (pre) was compared with three
postinterventional periods: directly after intensive implementation efforts
(post1), 2 years (post2) and 3 years (post3) after implementation. Setting
Five anaesthesiological-managed intensive care units (ICU) (one
cardiosurgical, one neurosurgical, two interdisciplinary and one intermediate
care) at a university hospital. Participants Adult patients with an ICU stay
of >48 h were included in the analysis. 1316 patients were included in the
analysis for a total of 12 965 ICU days. Intervention Implementation of a
CDSS. Outcome measures The primary end point was percentage of days with
guideline adherence during ICU treatment. Secondary end points were
antibiotic-free days and all-cause mortality compared for patients with low
versus high guideline adherence. Main results Adherence to guidelines
increased from 61% prior to implementation to 92% in post1, decreased in post2
to 76% and remained significantly higher compared with baseline in post3, with
71% (p=0.178). Additionally, antibiotic-free days increased over study
periods. At all time periods, mortality for patients with low guideline
adherence was higher with 12.3% versus 8% (p=0.014) and an adjusted OR of 1.56
(95% CI 1.05 to 2.31). Conclusions Implementation of computerised regional
adapted guidelines for antibiotic therapy is paralleled with improved
adherence. Even without further measures, adherence stayed high for a longer
period and was paralleled by reduced antibiotic exposure. Improved guideline
adherence was associated with reduced ICU mortality
