Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection: The INSPIRE Randomized Clinical...

Area of Science:

• Infectious Diseases
• Health Informatics
• Clinical Pharmacy

Background:

• Urinary tract infections (UTIs) are a common cause of hospitalization, frequently involving multidrug-resistant organisms (MDROs).
• Clinicians often overuse broad-spectrum antibiotics for UTIs, even in low-risk patients, necessitating strategies to curb this practice.

Purpose of the Study:

• To assess if computerized provider order entry (CPOE) prompts, offering patient- and pathogen-specific MDRO risk estimates, can decrease the use of empiric extended-spectrum antibiotics for UTI treatment.
• To evaluate the impact of a CPOE stewardship bundle on antibiotic selection for UTIs in noncritically ill adults.

Main Methods:

• A cluster-randomized trial involving 59 US community hospitals compared a CPOE stewardship bundle (education, feedback, risk-based prompts) with routine stewardship.
• The study analyzed antibiotic selection during the first 3 hospital days for noncritically ill adults hospitalized with UTI over baseline and intervention periods.

Main Results:

• The CPOE prompt group showed a 17.4% reduction in empiric extended-spectrum antibiotic days of therapy compared to routine stewardship.
• No significant differences were observed in safety outcomes, including days to intensive care unit (ICU) transfer and hospital length of stay.

Conclusions:

• Computerized provider order entry (CPOE) prompts, combined with feedback and education, effectively reduce empiric extended-spectrum antibiotic use in UTI patients with low MDRO risk.
• This approach offers a safe strategy to limit unnecessary antibiotic prescribing for UTIs without compromising patient outcomes.