Computerized alerts tailored to each patient help identify which antibiotic is best suited to treat patients hospitalized with common infections in two 92-hospital trials.
Two large multi-state studies funded by the National Institutes of Health and led by the University of California, Irvine, Harvard Pilgrim Health Care Institute, and HCA Healthcare have found a highly effective method to improve antibiotic selection for patients who are hospitalized with abdominal or skin and soft tissue infection to reduce their risk of antibiotic resistance. Results were published in JAMA Surgery and JAMA Internal Medicine and highlighted at the Congress of the European Society of Clinical Microbiology and Infectious Diseases.
Antibiotic resistance is a major public health threat. It makes infections harder to treat and adds additional risk to surgery and other procedures. The Centers for Disease Control & Prevention estimates that more than 2.8 million infections with antibiotic-resistant bacteria occur in the U.S. annually, and the World Health Organization attributed 1.27 million deaths to antibacterial resistance in 2019. 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 and serious adverse events, such as kidney/liver toxicity and C. difficile infection.
The two newly published studies, the INSPIRE Abdominal and Skin & Soft Tissue Trials, involved more than 316,000 patients in 92 HCA Healthcare hospitals. In half of the hospitals, clinicians were given computerized alerts with information about the best antibiotic match for an individual patient with abdominal or skin/soft tissue infection at the moment antibiotics were ordered. This resulted in a 35% improvement in antibiotic selection for abdominal infection patients and a 28% improvement for skin and soft tissue infection patients compared to the control group.
The alerts were informed by patient characteristics from the electronic medical record as well as hospital-specific data to determine the patient’s risk for an antibiotic-resistant infection. Assessment of risk was based on pre-trial data from more than 420,000 HCA Healthcare patients with abdominal or skin and soft tissue infections. Physicians treating patients with a low risk for antibiotic-resistant bacteria were prompted to switch to standard-spectrum antibiotics if they initially selected unnecessary broad-spectrum drugs.
This investigative team previously published results from another set of two trials that improved antibiotic selection in patients with pneumonia and urinary tract infection. Together, these INSPIRE studies represent the four most common infections requiring hospitalization that drive overuse of broad-spectrum antibiotics and show the value of harnessing electronic health data to improve best practice. These findings have the potential to improve care for millions of patients hospitalized with infections in the U.S., and HCA Healthcare has already implemented alerts based on the first two studies system-wide.
Physicians often choose extended-spectrum antibiotics that treat a very broad range of bacteria out of concern that their patients could be infected by antibiotic-resistant bacteria. The INSPIRE Trials identified patients with low risk for antibiotic resistance and prompted physicians to consider changing to standard-spectrum antibiotics if extended-spectrum antibiotics were being ordered. The trials found that giving physicians real-time information about their patients’ risk for antibiotic resistance worked significantly better to align antibiotic prescribing with current Infectious Diseases Society of America treatment recommendations.
“The right information at the right time can improve physician antibiotic selection,” said Shruti Gohil, MD, MPH, Associate Professor in the Division of Infectious Diseases at the University of California, Irvine School of Medicine. “Many different bacteria can cause abdominal or skin/soft tissue infections, and picking the best matched antibiotic can be a challenge. Results from these trials show that giving physicians an alert informing them of their patient’s actual risk for antibiotic resistance can help them choose the best antibiotic and reduce extended-spectrum antibiotic use.”
The 92 participating community hospitals spanned 15 states and are part of HCA Healthcare, one of the largest private inpatient healthcare systems in the U.S. The size of the studies involving a wide breadth of community hospitals support the likelihood that results are applicable to hospitals across the country. HCA Healthcare is in the process of implementing the new protocols at its 190 hospitals.
“HCA Healthcare is committed to using our scale and data ecosystem to answer important clinical questions that benefit patients. The ability to identify patients at low-risk for antibiotic resistance to limit the overall use of wide-spectrum antibiotics can help hospitals improve antibiotic stewardship efforts and curb resistance.”
Kenneth Sands, MD, MPH, chief epidemiologist at HCA Healthcare
The studies were conducted through a longstanding scientific collaboration including HCA Healthcare, Harvard Pilgrim Health Care Institute, and the University of California, Irvine.
Additional information about the INSPIRE Abdominal and Skin/Soft Tissue Trials can be found at: Editorial: Electronic Stewardship Prompts — Exploring the Why Behind the What
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