Implementation of automated alerts for last-resort antibiotics with indication review by infectious diseases specialists: impact on antibiotic prescription quality and costs.

PURPOSE: Infections caused by resistant pathogens represent a global public health challenge. In the current study we aimed to assess the effects on prescription quality and the economic impact of implementing an automated email alert system for last-resort antibiotics, followed by mandatory indication review by infectious diseases (ID) specialists. METHODS: A prospective single-centre economic and processual evaluation study of orders of last-resort antibiotics at a large tertiary care university hospital (2210 beds) in Germany was performed. Orders of ceftazidime/avibactam, ceftolozane/tazobactam, or cefiderocol triggered an indication review by ID specialists with subsequent recommendations to the primary treating physicians. Expected medication costs of continued therapy were compared to projected costs with adherence to ID recommendations. RESULTS: The spectrum of infections for which last-resort antibiotics were prescribed was broad, with respiratory, intraabdominal, skin and soft tissue infections representing > 60% of underlying entities. Dominant pathogens were Pseudomonas aeruginosa, Klebsiella spp. and Escherichia coli. ID specialists recommended modifications to the antibiotic regime in almost half of the alerts, including switching (21%), discontinuation (14%) and dosage modifications (7%). Potential cost savings by de-escalation to non-last-resort antibiotics or treatment discontinuation were 65,092€ per year (1,549 € per initial last-resort antibiotic prescription). Adherence analysis revealed that further improvement appears feasible, potentially through structured follow-up ID consultations. CONCLUSION: Implementation of automated last-resort antibiotic alerts, followed by an indication review by ID specialists, proved to be a valuable tool with respect to prescription quality and economic benefits. Generalisability of this approach should be investigated in non-tertiary care settings. Moreover, future studies should address potential effects on clinical outcomes and antimicrobial resistance patterns.