Computer prompt cuts extended-spectrum antibiotic use for abdominal infections by 35%
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Key takeaways:
- Abdominal infections are commonly treated with unnecessary extended-spectrum antibiotics.
- A computer prompt helped more than 90 hospitals improve their prescribing for these infections.
LOS ANGELES — A computer prompt recommending appropriate antibiotic use based on a patient’s level of risk for a resistant infection cut the use of extended-spectrum antibiotics for abdominal infections by around one-third in a large trial.
Shruti K. Gohil, MD, MPH, assistant professor of infectious diseases and associate medical director of epidemiology and infection prevention at the University of California, Irvine, presented findings from the cluster randomized INSPIRE trial at IDWeek.
[Editor’s note: Click here to see what Society for Healthcare Epidemiology of America President-elect David J. Weber, MD, MPH, had to say about the study.]
According to Gohil and colleagues, abdominal infections are one of the most commonly treated infections in U.S. hospitals, and the use of extended-spectrum antibiotics to treat them “far exceeds” the rate of resistant infections.
For the study, the researchers randomly assigned 92 hospitals in 15 states to use the prompt or continue with routine stewardship efforts for abdominal infections. Two of the hospitals dropped out, leaving 90 — 44 in the intervention arm and 46 that continued with routine care.
In the intervention arm, physicians who ordered extended-spectrum antibiotics for adult non-ICU patients being treated for abdominal infections received a computerized prompt displaying the patient’s individual risk for a multidrug-resistant organism. If the risk was below 10%, the prompt recommended standard-spectrum antibiotics instead of extended-spectrum drugs.
Risk models were calculated based on data from 225,000 patients who were treated for an abdominal infection from 2017 to 2019, Gohil said. Factors associated with a higher than 10% risk for a drug-resistant infection included history of a resistant infection and prior abdominal surgery.
Prompts differed depending on the case. Physicians could override a prompt but had to provide a reason for doing so, such as a patient allergy, Gohil said.
The primary outcome of the study was the number of days a patient received extended-spectrum antibiotics during the first 3 days after admission. Gohil and colleagues also tracked the use of vancomycin and antipseudomonal antibiotics as secondary outcomes, and used days to ICU transfer and length of stay as measures of safety.
After a 12-month baseline period and 5-month phase-in of the computer prompt, the researchers assessed the intervention over 12 months from January to December 2023.
The final study population included more than 105,000 patients — 54,384 who received routine care and 50,620 in the intervention arm. Patient characteristics were similar in both arms.
Over the course of the study, there was a 35% reduction in days of therapy with extended-spectrum antibiotics among patients in the prompt group compared with routine care (rate ratio = 0.65; 95% CI, 0.6-0.71), according to the researchers.
Secondary outcomes also favored the intervention, which reduced the use of vancomycin and antipseudomonals by 20% and 39%, respectively, Gohil and colleagues reported. There were no significant differences in length of stay or ICU transfers between the groups, demonstrating that the intervention was safe.
Although the intervention was a success, there is some question as to whether it went far enough, Gohil said.
“One wonders if a different alert threshold could have spared additional extended-spectrum antibiotic use,” she said.
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Gohil SK, et al. Abstract 444. Presented at: IDWeek; Oct. 16-19, 2024; Los Angeles.
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