Your browser doesn't support javascript.
loading
Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection: The INSPIRE Randomized Clinical Trial.
Gohil, Shruti K; Septimus, Edward; Kleinman, Ken; Varma, Neha; Avery, Taliser R; Heim, Lauren; Rahm, Risa; Cooper, William S; Cooper, Mandelin; McLean, Laura E; Nickolay, Naoise G; Weinstein, Robert A; Burgess, L Hayley; Coady, Micaela H; Rosen, Edward; Sljivo, Selsebil; Sands, Kenneth E; Moody, Julia; Vigeant, Justin; Rashid, Syma; Gilbert, Rebecca F; Smith, Kim N; Carver, Brandon; Poland, Russell E; Hickok, Jason; Sturdevant, S G; Calderwood, Michael S; Weiland, Anastasiia; Kubiak, David W; Reddy, Sujan; Neuhauser, Melinda M; Srinivasan, Arjun; Jernigan, John A; Hayden, Mary K; Gowda, Abinav; Eibensteiner, Katyuska; Wolf, Robert; Perlin, Jonathan B; Platt, Richard; Huang, Susan S.
Afiliação
  • Gohil SK; Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine.
  • Septimus E; Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts.
  • Kleinman K; Biostatistics and Epidemiology, University of Massachusetts, Amherst.
  • Varma N; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
  • Avery TR; Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts.
  • Heim L; Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine.
  • Rahm R; HCA Healthcare, Nashville, Tennessee.
  • Cooper WS; HCA Healthcare, Nashville, Tennessee.
  • Cooper M; HCA Healthcare, Nashville, Tennessee.
  • McLean LE; HCA Healthcare, Nashville, Tennessee.
  • Nickolay NG; HCA Healthcare, Nashville, Tennessee.
  • Weinstein RA; Rush University Medical Center, Cook County Health, Chicago, Illinois.
  • Burgess LH; HCA Healthcare, Nashville, Tennessee.
  • Coady MH; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
  • Rosen E; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
  • Sljivo S; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
  • Sands KE; Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts.
  • Moody J; HCA Healthcare, Nashville, Tennessee.
  • Vigeant J; HCA Healthcare, Nashville, Tennessee.
  • Rashid S; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
  • Gilbert RF; Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine.
  • Smith KN; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
  • Carver B; HCA Healthcare, Nashville, Tennessee.
  • Poland RE; HCA Healthcare, Nashville, Tennessee.
  • Hickok J; Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts.
  • Sturdevant SG; HCA Healthcare, Nashville, Tennessee.
  • Calderwood MS; HCA Healthcare, Nashville, Tennessee.
  • Weiland A; National Institutes of Health, Bethesda, Maryland.
  • Kubiak DW; Section of Infectious Disease and International Health, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
  • Reddy S; Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine.
  • Neuhauser MM; Brigham and Women's Hospital, Boston, Massachusetts.
  • Srinivasan A; Centers for Disease Control and Prevention, Atlanta, Georgia.
  • Jernigan JA; Centers for Disease Control and Prevention, Atlanta, Georgia.
  • Hayden MK; Centers for Disease Control and Prevention, Atlanta, Georgia.
  • Gowda A; Centers for Disease Control and Prevention, Atlanta, Georgia.
  • Eibensteiner K; Rush University Medical Center, Chicago, Illinois.
  • Wolf R; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
  • Perlin JB; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
  • Platt R; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
  • Huang SS; HCA Healthcare, Nashville, Tennessee.
JAMA ; 331(23): 2018-2028, 2024 06 18.
Article em En | MEDLINE | ID: mdl-38639723
ABSTRACT
Importance Urinary tract infection (UTI) is the second most common infection leading to hospitalization and is often associated with gram-negative multidrug-resistant organisms (MDROs). Clinicians overuse extended-spectrum antibiotics although most patients are at low risk for MDRO infection. Safe strategies to limit overuse of empiric antibiotics are needed.

Objective:

To evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO risk estimates could reduce use of empiric extended-spectrum antibiotics for treatment of UTI. Design, Setting, and

Participants:

Cluster-randomized trial in 59 US community hospitals comparing the effect of a CPOE stewardship bundle (education, feedback, and real-time and risk-based CPOE prompts; 29 hospitals) vs routine stewardship (n = 30 hospitals) on antibiotic selection during the first 3 hospital days (empiric period) in noncritically ill adults (≥18 years) hospitalized with UTI with an 18-month baseline (April 1, 2017-September 30, 2018) and 15-month intervention period (April 1, 2019-June 30, 2020).

Interventions:

CPOE prompts recommending empiric standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics who have low estimated absolute risk (<10%) of MDRO UTI, coupled with feedback and education. Main Outcomes and

Measures:

The primary outcome was empiric (first 3 days of hospitalization) extended-spectrum antibiotic days of therapy. Secondary outcomes included empiric vancomycin and antipseudomonal days of therapy. Safety outcomes included days to intensive care unit (ICU) transfer and hospital length of stay. Outcomes were assessed using generalized linear mixed-effect models to assess differences between the baseline and intervention periods.

Results:

Among 127 403 adult patients (71 991 baseline and 55 412 intervention period) admitted with UTI in 59 hospitals, the mean (SD) age was 69.4 (17.9) years, 30.5% were male, and the median Elixhauser Comorbidity Index count was 4 (IQR, 2-5). Compared with routine stewardship, the group using CPOE prompts had a 17.4% (95% CI, 11.2%-23.2%) reduction in empiric extended-spectrum days of therapy (rate ratio, 0.83 [95% CI, 0.77-0.89]; P < .001). The safety outcomes of mean days to ICU transfer (6.6 vs 7.0 days) and hospital length of stay (6.3 vs 6.5 days) did not differ significantly between the routine and intervention groups, respectively. Conclusions and Relevance Compared with routine stewardship, CPOE prompts providing real-time recommendations for standard-spectrum antibiotics for patients with low MDRO risk coupled with feedback and education significantly reduced empiric extended-spectrum antibiotic use among noncritically ill adults admitted with UTI without changing hospital length of stay or days to ICU transfers. Trial Registration ClinicalTrials.gov Identifier NCT03697096.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Urinárias / Sistemas de Registro de Ordens Médicas / Gestão de Antimicrobianos / Antibacterianos Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: JAMA Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Urinárias / Sistemas de Registro de Ordens Médicas / Gestão de Antimicrobianos / Antibacterianos Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: JAMA Ano de publicação: 2024 Tipo de documento: Article