Appl Clin Inform 2023; 14(03): 418-427
DOI: 10.1055/a-2054-0270
Research Article

Digital Antimicrobial Stewardship Decision Support to Improve Antimicrobial Management

Julia K. W. Yarahuan
1   Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
Kelly Flett
2   Novant Health Eastover Pediatrics, Charlotte, North Carolina, United States
Mari M. Nakamura
3   Antimicrobial Stewardship Program, Boston Children's Hospital, Boston, Massachusetts, United States
4   Department of Pediatrics, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, United States
Sarah B. Jones
3   Antimicrobial Stewardship Program, Boston Children's Hospital, Boston, Massachusetts, United States
5   Department of Pharmacy, Boston Children's Hospital, Boston, Massachusetts, United States
Andrew Fine
6   Department of Pediatrics, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, United States
R. Brandon Hunter
7   Department of Pediatrics, Division of Critical Care Medicine, Texas Children's Hospital, Houston, Texas, United States
› Author Affiliations
Funding U.S. Department of Health and Human Services; National Institutes of Health; U.S. National Library of Medicine; NLM Institutional Training grant number: T15LM007092-30.


Objectives We sought to create a digital application to support clinicians in empiric and pathogen-directed antibiotic ordering based on local susceptibility patterns and evidence-based treatment durations, thereby promoting antimicrobial stewardship.

Methods We formed a multidisciplinary team that met bimonthly from 2017 to 2018 to design and construct a web-based antimicrobial stewardship platform called Antibiogram + . We used an iterative and agile technical development process with frequent feedback from clinicians.

Results Antibiogram+ is an online tool, accessible via the electronic health record and hospital intranet, which offers institutional antibiotic susceptibilities for major pathogens, recommendations for empiric antibiotic selection and treatment durations for common pediatric conditions, antimicrobial dosing and monitoring guidance, and links to other internal clinical decision support resources. The tool was accessed 11,823 times with 492 average monthly views during the first 2 years after release. Compared with use of a preexisting print antibiogram and dosing card, pediatric residents more frequently reported “often” being sure of antibiotic dosing with Antibiogram+ (58 vs. 15%, p < 0.01). Respondents also reported improved confidence in choice of antibiotic, but this finding did not reach statistical significance (55 vs. 35%, p = 0.26).

Conclusion We report the successful development of a digital antimicrobial stewardship platform with consistent rates of access during the first 2 years following release and improved provider comfort with antibiotic management.

Protection of Human and Animal Subjects

The Boston Children's Hospital Institutional Review Board reviewed and approved this study.

Publication History

Received: 19 December 2022

Accepted: 12 March 2023

Accepted Manuscript online:
14 March 2023

Article published online:
31 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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