{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T23:47:52Z","timestamp":1782344872447,"version":"3.54.5"},"reference-count":42,"publisher":"Georg Thieme Verlag KG","issue":"03","funder":[{"name":"The Spanish Ministry of Science and Innovation (Ministerio de Ciencia e Innovaci\u00f3n \/ Agencia Estatal de Investigaci\u00f3n, AEI) and the European Union NextGenerationEU\/PRTR.","award":["project CPP2022-009977"],"award-info":[{"award-number":["project CPP2022-009977"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study aimed to develop and validate a targeted set of clinical rules embedded within a clinical decision support system to support safer antimicrobial dosing in patients with impaired renal function and to assist antimicrobial stewardship activities.<\/jats:p>\n                  <jats:p>Clinical rules for renal dose adjustment were developed through a structured literature review and consensus by a multidisciplinary team. The rules were implemented within a clinical decision support system integrated with electronic prescribing, electronic health records, and laboratory data, through HL7 messaging and supported by a NoSQL database architecture. A 9-week pilot validation study was conducted in a tertiary care hospital, during which alerts were reviewed by pharmacists. System effectiveness was assessed by alert review rates, pharmacist interventions, physician acceptance, and positive predictive value.<\/jats:p>\n                  <jats:p>A total of 58 clinical rules were implemented. During the validation period, 409 alerts were generated for 249 patients, of which 352 alerts (86%) were reviewed by pharmacists. Pharmacist interventions were performed for 190 alerts (54%). Among 156 assessable interventions, 111 (71%) were accepted by physicians, resulting in antimicrobial dose modifications. The overall positive predictive value of the clinical rule set was 0.32. Acceptance rates varied across clinical settings, ranging from 57% in surgical units to 80% in the emergency department.<\/jats:p>\n                  <jats:p>Implementation of a consensus-based bundle of clinical rules within a clinical decision support system generated actionable renal dosing alerts and supported pharmacist-led interventions with high prescriber acceptance. This informatics-enabled approach supports safer antimicrobial dosing decisions in patients with renal impairment and may help reduce the risk of medication-related harm.<\/jats:p>","DOI":"10.1055\/a-2893-7843","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T23:17:12Z","timestamp":1781219832000},"page":"502-509","source":"Crossref","is-referenced-by-count":0,"title":["A Clinical Decision Support System to Optimize Antimicrobial Dosing in Patients with Renal Impairment"],"prefix":"10.1055","volume":"17","author":[{"given":"Ana","family":"Garcia-Souto","sequence":"additional","affiliation":[{"name":"Gregorio Maranon General University Hospital Pharmacy Service, Community of Madrid, Spain","place":["Madrid"],"department":["Servicio de Farmacia"]},{"name":"Instituto de Investigaci\u00f3n Sanitaria del Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Ib\u00e1\u00f1ez-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Gregorio Maranon General University Hospital Pharmacy Service, Community of Madrid, Spain","place":["Madrid"],"department":["Servicio de Farmacia"]},{"name":"Instituto de Investigaci\u00f3n Sanitaria del Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2574-4076","authenticated-orcid":false,"given":"Beatriz","family":"Torroba-Sanz","sequence":"additional","affiliation":[{"name":"Gregorio Maranon General University Hospital Pharmacy Service, Community of Madrid, Spain","place":["Madrid"],"department":["Servicio de Farmacia"]},{"name":"Instituto de Investigaci\u00f3n Sanitaria del Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gonzalo","family":"Dom\u00ednguez-Chaparro","sequence":"additional","affiliation":[{"name":"Gregorio Maranon General University Hospital Pharmacy Service, Community of Madrid, Spain","place":["Madrid"],"department":["Servicio de Farmacia"]},{"name":"Instituto de Investigaci\u00f3n Sanitaria del Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Nu\u00f1ez-Nu\u00f1ez","sequence":"additional","affiliation":[{"name":"Hospital Universitario Cl\u00ednico San Cecilio, Spain","place":["Granada"],"department":["Servicio de Farmacia"]},{"name":"Instituto de Investigaci\u00f3n Biosanitaria IBS Granada, Spain","place":["Granada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Eugenia","family":"Velasco-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Biosanitaria IBS Granada, Spain","place":["Granada"]},{"name":"Universidad de Granada, Spain","place":["Granada"],"department":["Departamento de Estad\u00edstica e Investigaci\u00f3n Operativa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Luis","family":"de la Rosa-Trivi\u00f1o","sequence":"additional","affiliation":[{"name":"Ysengineers, S.L., Malaga, Spain","place":["Malaga"],"department":["Department of Information Systems"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Herranz-Alonso","sequence":"additional","affiliation":[{"name":"Gregorio Maranon General University Hospital Pharmacy Service, Community of Madrid, Spain","place":["Madrid"],"department":["Servicio de Farmacia"]},{"name":"Instituto de Investigaci\u00f3n Sanitaria del Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Sanjurjo-S\u00e1ez","sequence":"additional","affiliation":[{"name":"Gregorio Maranon General University Hospital Pharmacy Service, Community of Madrid, Spain","place":["Madrid"],"department":["Servicio de Farmacia"]},{"name":"Instituto de Investigaci\u00f3n Sanitaria del Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref3","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Antimicrobial Resistance Collaborators","year":"2022","journal-title":"Lancet"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1097\/QCO.0000000000000604","article-title":"Antibiotics and adverse events: the role of antimicrobial stewardship programs in \u201cdoing no harm.\u201d","volume":"32","author":"K A Bauer","year":"2019","journal-title":"Curr Opin Infect Dis"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"192","DOI":"10.4161\/viru.23706","article-title":"How to educate prescribers in antimicrobial stewardship practices","volume":"4","author":"C Pulcini","year":"2013","journal-title":"Virulence"},{"issue":"02","key":"ref6","first-page":"68","article-title":"Antimicrobial stewardship and dose adjustment of restricted antimicrobial drugs in hospital setting","volume":"11","author":"I Vlak","year":"2023","journal-title":"Pharmacy (Basel)"},{"key":"ref7","first-page":"67","volume-title":"Effect of renal and hepatic diseases on pharmacokinetics","author":"R Peeriga","year":"2024"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1097\/CCM.0b013e3181961bff","article-title":"Pharmacokinetic issues for antibiotics in the critically ill patient","volume":"37","author":"J A Roberts","year":"2009","journal-title":"Crit Care Med"},{"issue":"09","key":"ref9","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1007\/s40262-018-0636-7","article-title":"Augmented renal clearance in critically ill patients: a systematic review","volume":"57","author":"I Bilbao-Meseguer","year":"2018","journal-title":"Clin Pharmacokinet"},{"issue":"18","key":"ref10","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.2169\/internalmedicine.2603-18","article-title":"Association of adverse drug events with broad-spectrum antibiotic use in hospitalized patients: a single-center study","volume":"58","author":"H Hagiya","year":"2019","journal-title":"Intern Med"},{"issue":"07","key":"ref11","doi-asserted-by":"crossref","first-page":"e0158677","DOI":"10.1371\/journal.pone.0158677","article-title":"Pattern and predictors of medication dosing errors in chronic kidney disease patients in Pakistan: a single center retrospective analysis","volume":"11","author":"A Saleem","year":"2016","journal-title":"PLoS One"},{"issue":"10","key":"ref12","doi-asserted-by":"crossref","first-page":"e13579","DOI":"10.1111\/ijcp.13579","article-title":"Antibiotic dosing adjustments in patients with declined kidney function at a tertiary hospital in Jordan","volume":"74","author":"F Jarab","year":"2020","journal-title":"Int J Clin Pract"},{"key":"ref13","first-page":"183","article-title":"Evaluation of antibiotic dose adjustment based on glomerular filtration rate in patients who were admitted to Rasool-Akram hospital, Tehran, in 6 months of 2015","volume":"9","author":"A Reza","year":"2019","journal-title":"J Adv Pharm Educ Res"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1197\/jamia.M2049","article-title":"Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial","volume":"13","author":"J C McGregor","year":"2006","journal-title":"J Am Med Inform Assoc"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.jhin.2025.05.001","article-title":"Clinical decision support system to guide antimicrobial selection: a narrative review from 2019 to 2023","volume":"162","author":"A L Bienvenu","year":"2025","journal-title":"J Hosp Infect"},{"issue":"08","key":"ref16","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/j.cmi.2017.02.028","article-title":"A systematic review of clinical decision support systems for antimicrobial management: are we failing to investigate these interventions appropriately?","volume":"23","author":"T M Rawson","year":"2017","journal-title":"Clin Microbiol Infect"},{"issue":"10","key":"ref17","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1177\/0018578717726869","article-title":"Evaluation of antimicrobial stewardship related alerts using a clinical decision support system","volume":"52","author":"R J Ghamrawi","year":"2017","journal-title":"Hosp Pharm"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1086\/664762","article-title":"Implementation of a clinical decision support system for antimicrobial stewardship","volume":"33","author":"E D Hermsen","year":"2012","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.jhin.2018.07.034","article-title":"Participatory implementation of an antibiotic stewardship programme supported by an innovative surveillance and clinical decision-support system","volume":"100","author":"A S Sim\u00f5es","year":"2018","journal-title":"J Hosp Infect"},{"issue":"03","key":"ref20","doi-asserted-by":"crossref","first-page":"384","DOI":"10.3390\/antibiotics11030384","article-title":"Clinical decision support systems for antibiotic prescribing: an inventory of current French language tools","volume":"11","author":"C Durand","year":"2022","journal-title":"Antibiotics (Basel)"},{"issue":"02","key":"ref21","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1007\/s11096-019-00796-5","article-title":"Impact of pharmacists' interventions on physicians' decision of a knowledge-based renal dosage adjustment system","volume":"41","author":"K S Choi","year":"2019","journal-title":"Int J Clin Pharm"},{"issue":"03","key":"ref22","doi-asserted-by":"crossref","first-page":"731","DOI":"10.4338\/ACI-2016-01-RA-0010","article-title":"Renal drug dosing. Effectiveness of outpatient pharmacist-based vs. prescriber-based clinical decision support systems","volume":"7","author":"E A Vogel","year":"2016","journal-title":"Appl Clin Inform"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1136\/qshc.2007.025700","article-title":"Using a clinical decision support system to determine the quality of antimicrobial dosing in intensive care patients with renal insufficiency","volume":"19","author":"P J Helmons","year":"2010","journal-title":"Qual Saf Health Care"},{"issue":"05","key":"ref24","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1177\/10781552211019453","article-title":"The effect of a clinical decision support system on the frequency of dose adjustments of anticancer drugs in case of renal or hepatic dysfunction","volume":"28","author":"J Rolvink","year":"2022","journal-title":"J Oncol Pharm Pract"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1186\/s12911-022-01979-3","article-title":"OntoPharma: ontology based clinical decision support system to reduce medication prescribing errors","volume":"22","author":"E Calvo-Cidoncha","year":"2022","journal-title":"BMC Med Inform Decis Mak"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1186\/s12911-022-01885-8","article-title":"Development and assessment of PharmaCheck: an electronic screening tool for the prevention of twenty major adverse drug events","volume":"22","author":"C Skalafouris","year":"2022","journal-title":"BMC Med Inform Decis Mak"},{"issue":"03","key":"ref27","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1093\/intqhc\/mzi095","article-title":"Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit","volume":"18","author":"K A Thursky","year":"2006","journal-title":"Int J Qual Health Care"},{"issue":"09","key":"ref28","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1310\/hpj4809-744","article-title":"Impact of a clinical decision support system on pharmacy clinical interventions, documentation efforts, and costs","volume":"48","author":"S Calloway","year":"2013","journal-title":"Hosp Pharm"},{"key":"ref29","volume-title":"Challenges and Barriers to Clinical Decision Support (CDS) Design and Implementation Experienced in the Agency for Healthcare Research and Quality CDS Demonstrations","author":"J S Eichner","year":"2010"},{"issue":"03","key":"ref30","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1055\/s-0039-1693426","article-title":"Development and evaluation of a clinical decision support system to improve medication safety","volume":"10","author":"S Ib\u00e1\u00f1ez-Garcia","year":"2019","journal-title":"Appl Clin Inform"},{"key":"ref31","volume-title":"Gu\u00eda de terap\u00e9utica antimicrobiana 2024","author":"J Mensa Pueyo","year":"2024"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.18549\/PharmPract.2019.1.1304","article-title":"Evaluation of renal drug dosing adjustment in chronic kidney disease patients at two university hospitals in Lebanon","volume":"17","author":"R Saad","year":"2019","journal-title":"Pharm Pract (Granada)"},{"issue":"9887","key":"ref36","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/S0140-6736(13)60647-9","article-title":"Acute kidney injury: an increasing global concern","volume":"382","author":"N H Lameire","year":"2013","journal-title":"Lancet"},{"issue":"02","key":"ref37","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1093\/ndt\/gfw424","article-title":"Association between e-alert implementation for detection of acute kidney injury and outcomes: a systematic review","volume":"32","author":"P Lachance","year":"2017","journal-title":"Nephrol Dial Transplant"},{"issue":"03","key":"ref38","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1093\/jamia\/ocv159","article-title":"The impact of real-time alerting on appropriate prescribing in kidney disease: a cluster randomized controlled trial","volume":"23","author":"L Awdishu","year":"2016","journal-title":"J Am Med Inform Assoc"},{"issue":"01","key":"ref39","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s11255-021-02834-6","article-title":"Antibiotic dosing adjustments in hospitalized patients with chronic kidney disease: a retrospective chart review","volume":"54","author":"B Chahine","year":"2022","journal-title":"Int Urol Nephrol"},{"issue":"04","key":"ref40","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1055\/a-2341-8823","article-title":"Effects of a pharmacist-designed clinical decision support system on antimicrobial stewardship","volume":"15","author":"M\u00c1 Amor-Garc\u00eda","year":"2024","journal-title":"Appl Clin Inform"},{"issue":"02","key":"ref41","first-page":"85","article-title":"Clinical impact of accepting or rejecting a recommendation from a clinical decision support system-assisted antibiotic stewardship program","volume":"6","author":"E Nadeau","year":"2021","journal-title":"J Assoc Med Microbiol Infect Dis Can"},{"issue":"01","key":"ref42","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1186\/s13054-016-1456-5","article-title":"Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications","volume":"20","author":"G Villa","year":"2016","journal-title":"Crit Care"},{"issue":"09","key":"ref43","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1080\/14787210.2020.1764845","article-title":"Harmonizing antibiotic regimens with renal replacement therapy","volume":"18","author":"S M Jang","year":"2020","journal-title":"Expert Rev Anti Infect Ther"},{"issue":"05","key":"ref44","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1053\/j.ajkd.2010.05.024","article-title":"A computerized provider order entry intervention for medication safety during acute kidney injury: a quality improvement report","volume":"56","author":"A B McCoy","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.ijmedinf.2017.08.008","article-title":"Prescriber response to computerized drug alerts for electronic prescriptions among hospitalized patients","volume":"107","author":"Y Zenziper Straichman","year":"2017","journal-title":"Int J Med Inform"},{"issue":"04","key":"ref46","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1177\/2042098618760995","article-title":"Trigger alerts associated with laboratory abnormalities on identifying potentially preventable adverse drug events in the intensive care unit and general ward","volume":"9","author":"M S Buckley","year":"2018","journal-title":"Ther Adv Drug Saf"},{"issue":"07","key":"ref47","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1007\/s00228-019-02660-x","article-title":"A pharmacist-physician intervention model using a computerized alert system to reduce high-risk medication use in primary care","volume":"75","author":"B Cossette","year":"2019","journal-title":"Eur J Clin Pharmacol"}],"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2893-7843.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T23:05:27Z","timestamp":1782342327000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2893-7843"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":42,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2026,5,28]]},"published-print":{"date-parts":[[2026,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2893-7843","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1869-0327"],"issn-type":[{"value":"1869-0327","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6,11]]},"published":{"date-parts":[[2026,5]]}}}