The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review.

BACKGROUND: Inappropriate antimicrobial use has been shown to be an important determinant of the emergence of antimicrobial resistance (AMR). Health information technology (HIT) in the form of Computerised Decision Support (CDS) represents an option for improving antimicrobial prescribing and containing AMR. OBJECTIVES: To evaluate the evidence for CDS in improving quantitative and qualitative measures of antibiotic prescribing in inpatient hospital settings. METHODS: A systematic literature search was conducted of articles published from inception to 20th December 2014 using eight electronic databases: MEDLINE, EMBASE, PUBMED, Web of Science, CINAHL, Cochrane Library, HMIC and PsychINFo. An updated systematic literature search was conducted from January 1st 2015 to October 1st 2016 using PUBMED. The search strategy used combinations of the following terms: (electronic prescribing) OR (clinical decision support) AND (antibiotic or antibacterial or antimicrobial) AND (hospital or secondary care or inpatient). Studies were evaluated for quality using a 10-point rating scale. RESULTS: Eighty-one studies were identified matching the inclusion criteria. Seven outcome measures were evaluated: adequacy of antibiotic coverage, mortality, volume of antibiotic usage, length of stay, antibiotic cost, compliance with guidelines, antimicrobial resistance, and CDS implementation and uptake. Meta-analysis of pooled outcomes showed CDS significantly improved the adequacy of antibiotic coverage (n = 13; odds ratio [OR], 2.11 [95% CI, 1.67 to 2.66, p ≤ 0.00001]). Also, CDS was associated with marginally lowered mortality (n = 20; OR, 0.85 [CI, 0.75 to 0.96, p = 0.01]). CDS was associated with lower antibiotic utilisation, increased compliance with antibiotic guidelines and reductions in antimicrobial resistance. Conflicting effects of CDS on length of stay, antibiotic costs and system uptake were also noted. CONCLUSIONS: CDS has the potential to improve the adequacy of antibiotic coverage and marginally decrease mortality in hospital-related settings.

An unexpected case of Lyme disease in a soldier serving in northern Iraq.

Lyme disease is a tick-transmitted disease caused by the spirochete Borrelia burgdorferi. Cases have been reported across the United States, Canada, and Europe. Additional cases have been described in other parts of the world including Japan, Mexico, and Turkey. We report an unexpected case of Lyme disease from Iraq.

Guillain-Barré syndrome variant: presenting with myalgias and acute facial diplegia.

A patient with no significant medical history presented with myalgias, lower extremity weakness, and facial diplegia. Upon review of systems, the patient denied any other problems. Physical examination results were remarkable for weakness in the right leg and bilateral facial diplegia. Radiological and laboratory studies were unremarkable. Lumbar puncture revealed albuminocytological dissociation. The combined history, physical examination, and lumbar puncture results established a presumptive diagnosis of Guillain-Barré syndrome. The patient began a 5-day course of intravenous immunoglobulin therapy. At the end of the 5-day course, the patient had recovered 85% of her facial muscle function and experienced complete relief of her myalgias. Upon discharge, the patient was referred to physical therapy for improvement of her facial muscle impairment.

A fatal case of necrotizing fasciitis caused by Serratia marcescens.

A patient with a history of type II diabetes mellitus (DM), end stage renal disease (ESRD), and congestive heart failure (CHF) developed necrotizing fasciitis caused by Serratia marcescens after scraping his leg on rocks in a river while fishing. Aggressive management with surgical debridement, antibiotics, and pressure support was unsuccessful.