Clinical decision support system to guide antimicrobial selection: a narrative review from 2019 to 2023.

Background: Clinical decision support systems (CDSS) are increasingly developed to improve healthcare delivery.

Objectives: To update the last review on this topic, we conducted a narrative review aimed at describing all CDSS identified through searches of MEDLINE dedicated to antimicrobials prescribing from 2019 to 2023.

Materials and methods: All original research describing a CDSS dedicated to antimicrobials selection, including antibiotics, antivirals, antifungals, and antiparasitic drugs, were eligible. CDSS goals and their potential clinical impacts, as well as characteristics of studies for CDSS evaluation (type of study, population, setting, objectives, and main findings) were extracted.

Results: Among the 28 studies included, most (n=24) were dedicated to antibiotics and 15 were embedded in an electronic health record. Only one CDSS was developed in low and middle-income countries (LMIC). The main goal of the included CDSS was to assist clinicians in the selection of antimicrobials. Ten studies included more than 1 000 patients or prescriptions, and most of them were implemented in hospitals. Only six studies reported no impact of CDSS on antibiotic use or compliance with guidelines.

Conclusions: CDSS dedicated to antimicrobial prescribing is an area of increasing activity, with solutions offering the potential to optimise antimicrobial use. Although there is an urgent need to develop CDSS, CDSS clinical evaluation appears to be an important requirement before implementation. Special efforts are needed to ensure transferability of CDSS and high adoption, especially in LMIC, while improving awareness through education and training.