INSPIRE: Up to 40% of patients who are prescribed antibiotics in U.S. hospitals either do not require these drugs or receive inappropriate antibiotics for the condition being treated. Moreover, inappropriate antibiotics are often broad-spectrum, empirically prescribed in case of infection due to multidrug-resistant organisms (MDROs), despite the low risk of MDRO infection in the vast majority of clinical settings.

The focus of the INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection for Patients (INSPIRE-ASP) trial will be 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 will do this in two ways. First, we will create better models to predict individual patients’ likelihood of MDRO infection. Second, we will create and test 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 intend to reach our goal of influencing appropriate empiric antibiotic use.

The INSPIRE-ASP Trial is a two-arm cluster-randomized trial 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 will be 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 will provide clinicians with a patient-specific estimate of the likelihood that the pneumonia or UTI is due to the associated target pathogens. The smart prompt will also provide guidance for appropriate empiric antibiotic options per trial protocol and hospital policy.

Principal Investigators: Susan Huang, MD, MPH, Richard Platt, MD, MSc, Shruti Gohil, MD, MPH

Funder: Centers for Disease Control and Prevention