Any treatment with antibiotics can increase the development of resistant pathogenic microorganisms. Therefore, the use of antibiotics in a targeted manner in order to limit over- and under-treatment is essential. Bloodstream infections including sepsis are a widespread problem in hospitals and represent a major challenge for diagnostics and therapy.
The clinical Use Case HELP focuses on responsible antibiotic therapy for staphylococcal bloodstream infections. Coagulase-negative staphylococci are omnipresent – the bacteria are part of the normal skin flora and primarily colonize the reservoir in the nose. The detection of the microorganism is therefore questionable in the clinical significance of the finding. In 75 percent of the cases, the detection in the blood culture does not correspond to a bloodstream infection, but to a contamination. Nevertheless antibiotics are frequently administered. In most cases, this unjustified use of antibiotics promotes the development of antibiotic resistance and is associated with an increased risk of drug-related side effects.
In contrast, bloodstream infections caused by the aggressive pathogen Staphylococcus aureus always require antibiotic treatment. These infections are often associated with complications and have a high mortality rate of up to 25 percent. Several studies have shown that adherence to recommendations on therapy and diagnostics can reduce mortality by up to 50 percent.
The HELP App of the SMITH Consortium provides physicians with computer-based decision support for patients with evidence of staphylococci in their blood culture. The app provides the treating physicians with information on the next diagnostic and therapeutic steps in accordance to the guidelines. Apart from a direct improvement in patient care, this also contributes indirectly to the prevention of antibiotic-related multi-resistance and to the optimization of inpatient consultation by infectiologists.
The HELP Study is being conducted at five German University Hospitals in Aachen, Essen, Halle, Jena and Leipzig with the Jena University Hospital in charge of the project. In the first stage of the project, an electronic guide (HELP Manual) has been developed. It provides information on diagnosis and therapy of bloodstream infections with staphylococci and can be used as an app on stationary and mobile devices. In the second stage, the HELP App will be sustainably developed as a medical device in accordance with the European Medical Device Regulation.
HELP is used to validate the functionality of the Data Integration Centers (DIC) established in SMITH. In this process, routine data from health care are made accessible, quality-assured and used in anonymized form for the study evaluation. At the DICs, these data required for the study are converted into an interoperable data format and made available for use in research. The interoperable data format is based on the HL7 FHIR standard and the core data set of the Medical Informatics Initiative.
“We want to support the work of infectiologists in normal and intensive care units with IT in order to optimize the use of antibiotics for specific bacteria.”
Prof. Dr. André Scherag
1st Spokesman SMITH Consortium
Head of the HELP Use Case
Director of the Institute of Medical Statistics, Computer and Data Sciences (IMSID) | Jena University Hospital