Algorithm-driven alerts help identify best antibiotic for patients with pneumonia, UTI
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Key takeaways:
- Following algorithm-driven prompts led to a 28% reduction in empiric extended-spectrum days of therapy among patients with pneumonia.
- The prompts also led to a 17% reduction among patients with UTI.
Two studies assessing the use of algorithm-driven prompts meant to improve antibiotic selection for patients hospitalized with pneumonia or UTIs showed the prompts were effective, researchers found.
“Antibiotic resistance, which occurs when germs like bacteria and fungi mutate to defeat the drugs designed to kill them, is a major public health threat,” Shruti K. Gohil, MD, MPH, assistant professor of infectious diseases at the University of California Irvine School of Medicine and associate medical director of epidemiology and infection prevention in the Infectious Diseases School of Medicine, told Healio, adding that data show that 40% to 50% of patients hospitalized with pneumonia receive broad-spectrum antibiotics when they do not need them.
“Helping clinicians tailor antibiotic prescriptions to individual patients can improve patient outcomes by preserving healthy bacteria in the body and reducing the risk of future antibiotic resistance,” she said.
Through the INSPIRE trial, Gohil and colleagues assessed the effect of a computerized provider order entry (CPOE) stewardship bundle composed of education, feedback and real-time multidrug- resistant organism (MDRO) risk-based CPOE prompts that recommended standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics during the empiric period vs. routine stewardship efforts on antibiotic selection for patients being treated for pneumonia or UTIs.
According to the study, the trial encompassed all noncritically ill adult patients hospitalized for pneumonia or UTI at 59 community hospitals. The researchers compared an 18-month baseline period (April 1, 2017, to Sept. 30, 2018) to a 15-month intervention period (April 1, 2019, to June 30, 2020) to determine the impact of the intervention on empiric extended-spectrum antibiotic days of therapy.
In total, more than 220,000 patients with pneumonia or UTI were included in the study. Among patients with pneumonia, the trial showed that clinicians using CPOE prompts saw a 28.4% reduction in in empiric extended-spectrum days of therapy (rate ratio = 0.72; 95% CI, 0.66-0.78) compared with routine stewardship. For patients with UTI, clinicians using CPOE prompts saw a 17.4% reduction in empiric extended-spectrum days of therapy (rate ratio = 0.83; 95% CI, 0.77-0.89).
A safety analysis revealed that there was no difference in safety outcomes of ICU transfers or length of hospitalization between the two groups in either the pneumonia or UTI studies.
According to data from the pneumonia study, mean days to ICU transfer were 6.5 days for patients receiving routine care and 7.1 days for those receiving care per the CPOE intervention, whereas hospital length of stay was 6.8 days and 7.1 days, respectively. Among patients in the UTI study, the mean days to ICU transfer was 6.6 days for the patients receiving routine care and 7 days for the CPOE intervention group, whereas hospital length of stay was 6.3 and 6.5 days, respectively.
“Most patients with pneumonia and urinary tract infection are at low risk for MDROs,” Gohil said. “Real-time electronic health record generated recommendations for standard-spectrum antibiotics using patient-specific risk for MDRO-associated infections can safely reduce empiric extended-spectrum antibiotic use in patients hospitalized for pneumonia or UTI.”
References:
- Gohil SK, et al. JAMA. 2024;doi:10.1001/jama.2024.6248.
- Gohil SK, et al. JAMA. 2024;doi:10.1001/jama.2024.6259.
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Gohil SK, et al. JAMA. 2024;doi:10.1001/jama.2024.6248.
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