Researchers: Leonard Leibovici^1,2, Mical Paul³, Noa Elikim-Raz^1,2, Nariman Mansur^2,4, Tadmor Boaz^1,2

Background: TREAT is a computerized decision support system (DSS) for antibiotic treatment. It was installed in the departments of medicine at Beilinson Hospital in 2015; and in Rambam Hospital in 2017.

Objectives: Was to prove that the TREAT DSS improves patients’ outcomes and antibiotic usage in clinical practice.

Method: We have measured patients' outcomes and the use of antibiotics and compared the period before the installation of TREAT to the one while the system was installed. We are comparing outcomes in 1735 patients (before) to 5930 (after) in Beilinson; and 492 to 302 patients in Rambam Hospital.

Findings: The main outcome (percentage of appropriate antibiotic treatment out of patients with microbiologically documented infections) was improved by 24%-51%; fatality rate was decreased by 12%; the use of broad-spectrum antibiotics decreased, and the use of narrow-spectrum ones increased.

Conclusions: The usage of the system by the physicians declined until it was almost nil, and the system was discontinued. We believe that such a system is justified – no intervention in antibiotic stewardship showed such results – but it has to be adjusted to the users' needs. The system should be integrated seamlessly into the patient's electronic file. Data should be registered into one system; prescribing should be performed from the same system. The system should provide support for the dosing of antibiotics. The user should perceive the system as instantaneous or taking a very short time. A continuous effort should be made to educate users and encourage use,

Recommendations: A decision support system for antibiotic treatment improved treatment, patients' outcomes and reduced use of broad-spectrum antibiotics with unparalleled results. It failed with the users. It has promise as an important tool for antibiotic stewardship.

Research end date: 01/2019