INSPIRE-ASP UTI
Trial question
What is the role of computerized provider order entry prompts recommending standard-spectrum antibiotics in non-critically ill patients hospitalized with UTI?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
69.0% female
31.0% male
N = 55412
55412 patients (38221 female, 17191 male).
Inclusion criteria: non-critically ill adult patients hospitalized with UTI.
Key exclusion criteria: age < 18 years.
Interventions
N=27907 CPOE bundle (computerized provider order entry prompts recommending standard-spectrum antibiotics along with clinician education and feedback).
N=27505 routine stewardship (educational materials and quarterly coaching calls to maintain stewardship activities per national guidelines).
Primary outcome
Empiric extended-spectrum antibiotic days of therapy
326 days
446 days
446.0 days
334.5 days
223.0 days
111.5 days
0.0 days
CPOE
bundle
Routine
stewardship
Significant
decrease ▼
Significant decrease in empiric extended-spectrum antibiotic days of therapy (326 days vs. 446 days; RR 0.83, 95% CI 0.77 to 0.89).
Secondary outcomes
Significant decrease in vancomycin days of therapy (101.2 days vs. 124.7 days; RR 0.89, 95% CI 0.82 to 0.96).
Significant decrease in antipseudomonal days of therapy (178 days vs. 264.8 days; RR 0.79, 95% CI 0.72 to 0.87).
Safety outcomes
No significant differences in length of stay, days to ICU transfers, and days to antibiotic escalations.
Conclusion
In non-critically ill adult patients hospitalized with UTI, CPOE bundle was superior to routine stewardship with respect to empiric extended-spectrum antibiotic days of therapy.
Reference
Shruti K Gohil, Edward Septimus, Ken Kleinman et al. Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection: The INSPIRE Randomized Clinical Trial. JAMA. 2024 Jun 18;331(23):2018-2028.
Open reference URL