Empirical treatment of bacteraemic urinary tract infection. Evaluation of a decision support system

Brian Kristensen, Steen Andreassen, Leonard Leibovici, Christian Riekehr, Anders G. Kjœr, Henrik C. Schønheyder

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: In a Danish county with a low prevalence of antibiotic resistance to most antibiotics, we have constructed and evaluated a decision support system (DSS) for guidance of empirical antibiotic therapy in patients with bacteraemia originating from the urinary tract. Methodology: The DSS was based upon a causal probabilistic network, and a decision theoretic approach was used to balance the costs of antibiotic therapy against the therapeutic benefit. The costs included direct cost of pur- chasing antibiotics, side effects, and the risk of development of antibiotic resistance. The therapeutic benefit was defined as the increase in life-expectancy caused by antibiotic therapy. Life-years were chosen as the common currency unit. Four hundred and ninety-one bacteraemias seen during 19921994 were used to construct the DSS (derivation set), and 426 bacteraemias during 1995-1996 were used for evaluation (validation set). The cases were identified in a regional register of bacteraemias. The study was non-interventional. Results: The DSS suggested antibiotics which would provide coverage in 377 of the 426 episodes (88.5%) compared to 259 episodes (60.8%) for which empirical therapy actually provided coverage (p<0.01, McNemar-test). The regimens suggested by the DSS included mecillinam as monotherapy in 240 episodes (56.3%) gentamicin as monotherapy in 81 (19.0%), and a combination of gentamicin and ampicillin in 80 (18.8%). Conclusion: A decision theoretic approach shows promise of improving empirical antibiotic treatment, and may be a measure to support antibiotic policy.

Original languageEnglish
Pages (from-to)349-353
Number of pages5
JournalDanish Medical Bulletin
Volume46
Issue number4
StatePublished - Sep 1999

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