Introduction
Optimizing postoperative antimicrobial therapy is a major priority in modern surgical practice due to rising antimicrobial resistance and the persistent risk of healthcare-associated infections. The integration of Clinical Decision Support Systems (CDSSs) has emerged as an effective strategy to guide evidence-based prescribing, standardize antimicrobial use, and enhance patient safety. In the context of a multi-year quasi-experimental study, CDSS implementation in a primary-level hospital demonstrated measurable improvements in antimicrobial stewardship within diverse surgical specialties. By analyzing antimicrobial consumption, expenditure trends, and clinical outcomes such as mortality and length of stay, this research highlights the transformative potential of informatics-driven interventions in surgical environments. The findings underscore how targeted digital stewardship can support more rational drug use without compromising patient outcomes.
Impact of CDSS on Antimicrobial Consumption in Surgical Patients
Clinical Decision Support Systems significantly influenced postoperative antimicrobial prescribing patterns by promoting more rational and standardized usage. A 4.4% overall reduction in antimicrobial consumption demonstrates the efficiency of CDSS-driven optimization, while large decreases in specific drug classes such as aminoglycosides (−52.0%), macrolides, lincosamides and streptogramins (−40.6%), and fluoroquinolones (−32.3%) indicate targeted improvements. These reductions reflect a shift away from broad-spectrum or high-toxicity agents, supporting safer and more appropriate therapeutic choices. This research reveals the value of CDSS tools in modifying prescribing behavior and reducing unnecessary exposure to antimicrobials, which in turn helps limit the development of antimicrobial resistance.
Variability in Antimicrobial Stewardship Outcomes Across Surgical Specialties
The study illustrates how the impact of CDSS may differ across surgical services due to variations in workflow, infection risk, and prescribing habits. Traumatology and Urology showed the most significant reductions in antimicrobial consumption—21.3% and 14.3%, respectively—highlighting areas where CDSS recommendations aligned strongly with clinical practice. These heterogeneous outcomes reinforce the importance of specialty-specific stewardship strategies and suggest that tailored CDSS algorithms may further enhance prescribing accuracy. Understanding the dynamics within individual surgical departments enables hospitals to refine stewardship interventions for maximum clinical and operational benefit.
Influence of CDSS on Antimicrobial Expenditures and Hospital Resource Optimization
The downward trend in antimicrobial expenditures—from 3185.4 to 2733.9 €/1000 patient-days (−14.2%)—demonstrates that CDSS-supported stewardship can effectively reduce pharmacy costs. Although the change did not reach statistical significance (p = 0.17), the financial impact indicates potential long-term savings, especially in high-consumption settings. Reduced use of expensive broad-spectrum antibiotics directly contributes to budget optimization, while improved prescribing efficiency may also reduce downstream costs associated with adverse events or antimicrobial resistance. This topic highlights the economic value of integrating CDSS technologies within hospital stewardship programs.
Clinical Outcomes: Mortality Stability and Reductions in Length of Stay
A central strength of the CDSS-driven antimicrobial stewardship approach is that it improved resource utilization without compromising patient safety. Mortality rates remained stable, confirming that reduced antimicrobial exposure did not negatively affect clinical outcomes. Significant reductions in length of stay (LOS) were observed in key surgical services—Urology (5 to 4 days) and Traumatology (16 to 8.5 days)—suggesting faster recovery and fewer complications. These improvements reflect timely de-escalation, discontinuation, and optimization of therapy, supporting the role of CDSS in enhancing both patient flow and clinical efficiency within surgical departments.
Stewardship Interventions and Acceptance of CDSS Recommendations
High acceptance of stewardship recommendations (76.1%) demonstrates strong clinician engagement with CDSS-guided antimicrobial management. The most frequent interventions—discontinuation of antimicrobials (25.8%), transition to oral therapy (21.0%), and de-escalation (18.7%)—reflect core stewardship principles aimed at minimizing unnecessary exposure while maintaining therapeutic effectiveness. The substantial number of recommendations issued (476 for 330 patients) highlights the proactive nature of the CDSS in identifying optimization opportunities. This topic emphasizes how integrating decision support into clinical workflows can strengthen stewardship culture, enhance prescriber confidence, and promote sustainable antimicrobial use.
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