The focus of the INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection for Patients (INSPIRE-ASP) trials was to improve empiric inpatient antibiotic selection at the time of admission for the two most common conditions for antibiotic prescribing upon admission, pneumonia and urinary tract infection (UTI). We did this in two ways. First, we created better models to predict individual patients’ likelihood of MDRO infection. Second, we created and tested the impact of real-time prompts that provide prescribers with the probability that a specific patient’s pneumonia or UTI is due to an MDRO. With this two-pronged approach we aimed to reach our goal of influencing appropriate empiric antibiotic use.
The INSPIRE-ASP Trials were two-arm cluster-randomized trials in HCA hospitals comparing routine empiric antibiotic prescribing for patients to prescribing informed by point-of-care precision medicine computerized physician order entry (CPOE) smart prompt for adult patients. For facilities assigned to the intervention arm, an INSPIRE CPOE smart prompt triggered when physicians prescribe an extended-spectrum antibiotic for a pneumonia or UTI indication in the first three days of a hospital stay. This CPOE smart prompt provided clinicians with a patient-specific estimate of the likelihood that the pneumonia or UTI is due to the associated target pathogens. The smart prompt also provided guidance for appropriate empiric antibiotic options per trial protocol and hospital policy. The intervention period ended June 2020, and publications are pending review. Abstracts describing the preliminary results from the trials (UTI and pneumonia) were presented at the IDWeek 2021 conference.
In 2020, NIAID funded the study team to conduct the INSPIRE Trials for Abdominal and Skin and Soft Tissue Infections within HCA Healthcare facilities. These are ongoing 92-hospital cluster randomized trials of the CPOE prompts to reduce unnecessary broad spectrum empiric antibiotics for patients hospitalized with intra-abdominal and skin and soft tissue infections. Mirroring the earlier trials, the CPOE intervention is coupled with in-service education programs, site-based champions, and monthly feedback to hospitals’ leaders of each hospital’s performance. The intervention period ends in December 2023.
Publications and/or Presentations
Gohil SK, Septimus E, Kleinman K, Varma N, Heim L, Rashid S, Rahm R, Cooper W, McLean L, Nicolay N, Weinstein RA, Rosen E, Avery TR, Sjlivo S,, Vigeant J, Sands K, Cooper M, Burgess H, Moody J, Coady MH, Gilbert R, Smith K, Carver B, Spencer-Smith C, Poland R, Sturdevant G, Nikolaeva A, Hayden MK, Reddy S, Neuhauser M, Srinivasan A, Kubiak D, Jernigan JA, Perlin J, Platt R, Huang SS. INSPIRE-ASP pneumonia trial: a 59 hospital cluster randomized evaluation of intelligent stewardship prompts to improve real-time empiric antibiotic selection versus routine antibiotic selection practices for patients with pneumonia. Oral Presentation. ID Week 2021 (7th Annual Joint Meeting of IDSA, SHEA, HIVMA and PIDS) September 28-October 2, 2021 virtual conference.
Gohil SK, Septimus E, Kleinman K, Varma N, Heim L, Rashid S, Rahm R, Cooper W, McLean L, Nicolay N, Weinstein RA, Rosen E, Avery TR, Sjlivo S,, Vigeant J, Sands K, Cooper M, Burgess H, Moody J, Coady MH, Gilbert R, Smith K, Carver B, Spencer-Smith C, Poland R, Sturdevant G, Nikolaeva A, Hayden MK, Reddy S, Neuhauser M, Srinivasan A, Jernigan JA, Perlin J, Platt R, Huang SS. INSPIRE-ASP UTI trial: a 59 hospital cluster randomized evaluation of intelligent stewardship prompts to improve real-time empiric antibiotic selection versus routine antibiotic selection practices for patients with urinary tract infection (UTI). Poster Presentation. ID Week 2021 (7th Annual Joint Meeting of IDSA, SHEA, HIVMA and PIDS) September 28-October 2, 2021 virtual conference.[PL1]