Improving Empiric Antibiotic Selection for Patients Hospitalized With Abdominal Infection: The INSPIRE 4 Cluster...

Area of Science:

• Infectious Diseases
• Clinical Informatics
• Antibiotic Stewardship

Background:

• Empiric extended-spectrum antibiotics are frequently prescribed for hospitalized patients with abdominal infections, despite low rates of multidrug-resistant organism (MDRO) infections.
• Overuse of broad-spectrum antibiotics contributes to the development of antimicrobial resistance and increases healthcare costs.

Purpose of the Study:

• To determine if computerized provider order entry (CPOE) prompts can reduce empiric extended-spectrum antibiotic use in non-critically ill patients with abdominal infections.
• To assess the impact of CPOE prompts providing patient- and pathogen-specific MDRO infection risk estimates on antibiotic selection.

Main Methods:

• A 92-hospital cluster randomized clinical trial compared an antibiotic stewardship bundle with CPOE prompts against routine stewardship.
• The intervention involved CPOE prompts recommending standard-spectrum antibiotics for patients with <10% estimated absolute risk of MDRO abdominal infection.
• The study analyzed antibiotic selection during the first 3 hospital days (empiric period) for non-critically ill adults hospitalized with abdominal infection.

Main Results:

• The group receiving CPOE prompts showed a 35% relative reduction in empiric extended-spectrum antibiotic days of therapy compared to routine care.
• No significant increase in intensive care unit (ICU) transfers or hospital length of stay was observed in the CPOE prompt group.
• The CPOE bundle intervention led to a substantial decrease in the use of broad-spectrum antibiotics for abdominal infections.

Conclusions:

• Computerized provider order entry (CPOE) prompts are effective in reducing unnecessary extended-spectrum antibiotic use for abdominal infections in low-risk patients.
• This intervention improves antibiotic stewardship without compromising patient safety, as measured by ICU transfers and hospital length of stay.
• Implementing CPOE-based decision support can be a valuable strategy to combat antimicrobial resistance.