Extended-Spectrum Antibiotic Prescription Reduced With Help of Stewardship Prompt

A new analysis of four randomized clinical trials “provides evidence that a stewardship prompt embedded in a hospital’s electronic health record…can help reduce unnecessary use of extended-spectrum antibiotics.” CIDRAP has the news.

The findings come from a research letter published in JAMA by the team of researchers who conducted the INSPIRE (Intelligent Stewardship Prompts to Improve Real-Time Antibiotic Selection) trials. In those trials, the investigators “evaluated the impact of computerized provider order entry (CPOE) prompts for patients receiving empiric antibiotics” for pneumonia, UTIs, intra-abdominal infections (IAI), and skin or other soft-tissue infection (SSTI).

The CPOE prompt was meant to inform clinicians “within the first 3 days of hospitalization…that the patient has a less than 10% risk of infection with a multidrug-resistant organism (MDRO) and can be prescribed a standard-spectrum antibiotic.” The four trials found that hospitals that utilized the CPOE prompts “reduced initial extended-spectrum antibiotic use” by 17 to 35 percent for patients with different infections.

The current study involved the lead investigator and his collaborators setting out to “see whether those initial reductions were sustained during the patients’ remaining hospitalization.” Compared with hospitals that used routine stewardship, “the CPOE hospitals saw post-empiric extended-spectrum days of therapy fall” by about 20% for patients with pneumonia, IAIs, and SSTIs, and 11% for patients in the UTI trial.