INSPIRE Trials: Reducing Antibiotic Prescribing For Skin and Soft Tissue And Abdominal Infections
Led by Shruti K. Gohil, MD, MPH, the trials examined how computerized physician order entry prompts can reduce the use of extended-spectrum antibiotics in hospitalized patients while maintaining patient safety.
At IDWeek, we interviewed lead investigator Shruti K. Gohil, MD, MPH, assistant professor of infectious disease and associate medical director of epidemiology and infection prevention at the University of California, Irvine, about the INSPIRE trials. She described these two randomized controlled studies evaluated the use of real-time risk estimates and prompt-based clinical decision support to reduce extended-spectrum antibiotic use in hospitalized patients with infections. Conducted across 92 hospitals, 15 states, and involving over 300,000 patients, the trials demonstrated a 28% reduction in antibiotic use for skin and soft tissue infections and up to 35% for abdominal infections. Importantly, the intervention did not compromise patient safety, as there were no changes in ICU transfer rates or hospital length of stay. The trials aim to shift clinical practice toward initial narrow-spectrum antibiotic use, potentially mitigating the rise of multidrug-resistant organisms.
Insights Into The Trials
Hospital Cluster Randomized Trial of Intelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection versus Routine Antibiotic Selection Practices for Patients with Skin and Soft Tissue Infections
Up to 40% of hospitalized patients are prescribed extended-spectrum (ES) antibiotics, even when their risk of multidrug-resistant organism (MDRO) infection is low, raising concerns about adverse effects and future resistance. We assessed whether computerized physician order entry (CPOE) prompts with patient-specific MDRO risk estimates could decrease ES antibiotic use compared to standard stewardship practices in patients with skin and soft tissue (SST) infections.1
During the baseline and intervention periods, there were 60,654 non-ICU patients with SST infections in the routine care group and 57,655 in the CPOE prompt group. The CPOE prompt group experienced a 28% reduction in ES-DOT compared to routine care (rate ratio 0.72 (95% CI 0.67-0.79), p < 0.001). Anti-pseudomonal DOT also decreased by 28%, with no significant differences in length of stay or ICU transfers.1
The INSPIRE CPOE prompts provided patient-specific MDRO risk estimates and recommended standard-spectrum antibiotics for low-risk patients, significantly reducing empiric ES prescribing in adults with SST infections.1
Hospital Cluster Randomized Trial of Intelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection versus Routine Antibiotic Selection Practices for Patients with Abdominal Infections.
Similarly, up to 40% of hospitalized patients receive empiric ES antibiotics despite low risk for MDRO infections, heightening the risk of adverse effects and future resistance. We investigated whether CPOE prompts that offer patient-specific MDRO risk estimates could reduce ES antibiotic use compared to routine stewardship in patients with abdominal infections.2
During the baseline and intervention periods, there were 100,890 non-ICU patients with abdominal infections in the routine care group and 97,680 in the CPOE prompt group. The CPOE prompt group showed a 35% reduction in ES-DOT compared to routine care (rate ratio 0.65 (95% CI 0.60-0.71), p < 0.001). Vancomycin and anti-pseudomonal DOT decreased by 20% and 39%, respectively, with no significant differences in length of stay or ICU transfers.2
The INSPIRE CPOE prompts provided patient-specific MDRO risk estimates and recommended standard-spectrum antibiotics for low-risk patients, significantly reducing empiric ES prescribing in adults with abdominal infections.2
References
INSPIRE Trial: A 92-Hospital Cluster Randomized Trial of Intelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection versus Routine Antibiotic Selection Practices for Patients with Skin and Soft Tissue Infections. Presentation #179 presented at IDWeek 2024. October 16-19, 2024. Los Angeles, CA.
SHEA FEATURED ORAL ABSTRACT: INSPIRE Trial: A 92-Hospital Cluster Randomized Trial of INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection versus Routine Antibiotic Selection Practices for Patients with Abdominal Infections. Presentation #444 presented at IDWeek 2024. October 16-19, 2024. Los Angeles, CA.
