Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection: The INSPIRE Randomized Clinical Trial

A study in 59 US community hospitals compared the effect of computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific multidrug-resistant organisms (MDROs) risk estimates on antibiotic selection during the first 3 hospital days of UTI treatment in noncritically ill adults. The primary outcome was empiric extended-spectrum antibiotic days of therapy, secondary outcomes included empiric vancomycin and anti-seudomonal days of therapy, safety outcomes included days to intensive care unit (ICU) transfer and hospital length of stay. The results showed that CPOE prompts provided real-time recommendations for standard-spectrum antibiotics for patients with low MDRO risk, coupled with feedback and education, significantly reduced empiric extended-spectrum antibiotic use among non-critically ill adults admitted with UTI without changing hospital length of stay or days to ICU transfers.