BACKGROUND
Clinical decision support systems (CDSSs) are increasingly being used by clinicians to support antibiotic decision making in infection management. However, coexisting CDSSs often target different types of physicians, infectious situations and patient profiles.
OBJECTIVE
The objective of this study was to perform an up-to-date inventory of French-language clinical decision support systems (CDSSs) currently used in community and hospital settings for antimicrobial prescribing and to describe their main characteristics.
METHODS
A literature search, a search among mobile application stores and an open discussion with antimicrobial stewardship (AMS) experts were conducted in order to identify all French-language CDSSs available. Any clinical decision support tool that provides a personalized recommendation based on a clinical situation and/or a patient was included. A data collection form was developed and reviewed by infectious disease and AMS specialists. Collected data included the CDSS characteristics regarding administration, access, targeted users and patients, search criteria and type of information provided.
RESULTS
Eleven CDSSs were identified through the search strategy. Most CDSSs were designed on a regional scale by multidisciplinary teams and were intended for both inpatient and outpatient care. The majority of CDSSs were available free of charge (n=8/11, 73%). Only 2 CDSSs were designed exclusively for ambulatory care. Most CDSSs were accessible via smartphone applications (n=9/11, 82%) and online websites (n=8/11, 73%). Recommendations for antibiotic prescribing in urinary tract infections, upper and lower respiratory tract infections and digestive tract infections were provided by over 90% of the CDSSs. Recommendations for the treatment of cardiovascular infections, bloodstream infections and central venous catheter-related infections were advised by less than half of the CDSSs. More than 90% of the CDSSs displayed recommendations for antibiotic selection, prioritization, dosage, duration, route of administration and alternatives in case of allergy. Information about antibiotic side effects, prescribing recommendations for specific patient profiles and adaptation to local epidemiology were often missing or incomplete.
CONCLUSIONS
There is a significant but heterogeneous offer for antibiotic prescribing decision support. Standardized evaluation of these systems is needed to assess their impact on antimicrobial prescribing and antimicrobial resistance.