A program that used automated prompts to deliver patient-specific risk information to clinicians led to significant reductions in the use of extended-spectrum antibiotics for hospitalized patients, according to the INSPIRE trials.
The results of the trials were published online ahead of print in JAMA Internal Medicine and JAMA Surgery.
INSPIRE, an NIH Collaboratory Trial, consists of 2 cluster randomized trials that used personalized clinical decision support to improve judicious antibiotic prescribing for non–critically ill hospitalized patients with abdominal or skin and soft tissue infections.
Although fewer than 5% of such patients have an antibiotic-resistant infection, more than half receive extended-spectrum antibiotics. Tools to support judicious antibiotic prescribing are needed to curb the public health threat of antibiotic resistance. More than 2.8 million antimicrobial-resistant infections occur each year in the United States alone, and more than 35,000 people die as a result, according to the Centers for Disease Control and Prevention.
Conducted at 92 hospitals in the United States, INSPIRE compared routine care under hospital-based antibiotic stewardship programs with an enhanced program that added a predictive algorithm to reduce unnecessary prescribing of extended-spectrum antibiotics. The computerized provider order entry system at the intervention sites notified physicians when the antibiotic they selected was discordant with the estimated need for that antibiotic.
In the skin and soft tissue infections trial, which included 60,725 patients, the automated prompts reduced the use of empiric extended-spectrum antibiotics targeting Pseudomonas and multidrug-resistant gram-negative bacteria by 28% without increasing intensive care unit admissions or hospital length of stay. Read the full report in JAMA Internal Medicine.
Likewise, in the abdominal infection trial, among 105,004 patients, the prompts led to a 35% relative reduction in empiric extended-spectrum antibiotic days of therapy without increasing intensive care unit transfers or length of stay. Read the full report in JAMA Surgery.
In an invited commentary accompanying the JAMA Surgery report, Joshua Brown of the University of Pittsburgh Medical Center wrote, “Now that Gohil and colleagues have shown efficacy of their intervention, the next big question is how well it will scale to be implemented broadly.”
“These trials represent a major step forward for the field of antibiotic stewardship,” wrote Shinya Hasegawa and Daniel Livorsi of University of Iowa Health Care in an editorial in JAMA Network Open. “By next exploring the why behind the bundle’s success, strategies to replicate INSPIRE can be developed and tailored to a variety of hospital settings.”
INSPIRE is supported within the NIH Pragmatic Trials Collaboratory by a grant from the National Institute of Allergy and Infectious Diseases. Shruti Gohil of the University of California, Irvine, is INSPIRE’s lead investigator. Susan Huang of UC Irvine and Richard Platt of the Harvard Pilgrim Health Care Institute are the co–principal investigators.