Researchers at the university hospitals in Jena, Aachen, Essen, Halle and Leipzig have developed an app that supports doctors in the treatment of bloodstream infections with staphylococci. The app was evaluated in a large prospective multicentre study at five university hospitals with more than 5,000 patients. The study was able to prove the safety of the app and it could also be helpful for hospitals without their own infectiological expertise. The study was also one of the first successful test runs of an IT infrastructure that enables cross-site research with routine clinical data.

Staphylococci play a significant role in causing bloodstream infections. The bacterium Staphylococcus aureus is particularly dangerous and associated with a high mortality rate, and must be treated very quickly and in a targeted manner. Because other staphylococci are part of the skin flora, they are also often found in blood samples without the presence of an infection. For appropriate antibiotic treatment, doctors therefore consult an infectiological expert if possible in the event of a positive staphylococcus finding. However, this special expertise is not available in many hospitals.

The HELP manual as a digital decision-making aid

In order to close this gap in care, a study team at Jena University Hospital (JUH), together with partners from infectiology and medical microbiology from the university hospitals in Aachen, Essen, Halle and Leipzig, developed the HELP manual: an app that offers clinicians simple decision-making support. The manual guides them through the initial diagnostic and therapeutic steps for suspected staphylococcal infections in line with guidelines.

HELP study tests the infrastructure of the medical informatics initiative

"We then tested the app in a prospective multicentre study. This was also a test run for the networked data integration centres that were established at the five sites as part of the SMITH consortium of the Medical Informatics Initiative," says Prof. Dr André Scherag from Jena University Hospital (JUH), who is the head of the study and the first spokesperson for SMITH. These centres can convert data from the electronic patient file, for example on laboratory findings and therapies, into a standardized form and make it usable for research projects. Data protection and data security requirements are strictly observed.

Treatment results no worse

In total, data from 5,056 patients in 134 intensive care and normal wards at the five participating university hospitals were included in the study. The study team gradually introduced the use of the HELP manual on the wards and compared the treatment outcomes with and without the manual. "As a result, mortality on wards with the HELP manual was slightly lower than on wards without the app," says first author Julia Palm. "No difference was proven for long-term mortality, the recurrence of infections or the use of antibiotics."

In a further survey, 40 doctors on the participating wards were asked about the user-friendliness of the HELP manual. Around half stated that they had used the HELP manual. The majority of them rated the app as very user-friendly. Julia Palm: "The results of our study suggest that the HELP manual could provide valuable support, especially in smaller hospitals without infectiological expertise. However, the benefits of such digital systems depend on how well they can be integrated into existing hospital IT structures."

André Scherag adds: "During the study, which was partly conducted during the pandemic, it once again became clear what a challenge the IT reality in hospitals and the status quo of their digitalization poses for the use of scientific data. This makes the evidence provided that the cross-site harmonization and evaluation of data via the data integration centres works all the more important. The ability to use routine clinical data from patient care for research will make it easier to conduct future studies. And the results of these studies are the foundation for better patient care."