1. Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection
- Author
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Gohil, Shruti K, Septimus, Edward, Kleinman, Ken, Varma, Neha, Avery, Taliser R, Heim, Lauren, Rahm, Risa, Cooper, William S, Cooper, Mandelin, McLean, Laura E, Nickolay, Naoise G, Weinstein, Robert A, Burgess, L Hayley, Coady, Micaela H, Rosen, Edward, Sljivo, Selsebil, Sands, Kenneth E, Moody, Julia, Vigeant, Justin, Rashid, Syma, Gilbert, Rebecca F, Smith, Kim N, Carver, Brandon, Poland, Russell E, Hickok, Jason, Sturdevant, SG, Calderwood, Michael S, Weiland, Anastasiia, Kubiak, David W, Reddy, Sujan, Neuhauser, Melinda M, Srinivasan, Arjun, Jernigan, John A, Hayden, Mary K, Gowda, Abinav, Eibensteiner, Katyuska, Wolf, Robert, Perlin, Jonathan B, Platt, Richard, and Huang, Susan S
- Subjects
Medical Microbiology ,Biomedical and Clinical Sciences ,Clinical Sciences ,Infectious Diseases ,Urologic Diseases ,Patient Safety ,Women's Health ,Infection ,Adult ,Aged ,Female ,Humans ,Male ,Middle Aged ,Anti-Bacterial Agents ,Antimicrobial Stewardship ,Drug Resistance ,Multiple ,Bacterial ,Hospitals ,Community ,Length of Stay ,Medical Order Entry Systems ,Urinary Tract Infections ,Aged ,80 and over ,Medical and Health Sciences ,General & Internal Medicine ,Biomedical and clinical sciences ,Health sciences - Abstract
ImportanceUrinary tract infection (UTI) is the second most common infection leading to hospitalization and is often associated with gram-negative multidrug-resistant organisms (MDROs). Clinicians overuse extended-spectrum antibiotics although most patients are at low risk for MDRO infection. Safe strategies to limit overuse of empiric antibiotics are needed.ObjectiveTo evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO risk estimates could reduce use of empiric extended-spectrum antibiotics for treatment of UTI.Design, setting, and participantsCluster-randomized trial in 59 US community hospitals comparing the effect of a CPOE stewardship bundle (education, feedback, and real-time and risk-based CPOE prompts; 29 hospitals) vs routine stewardship (n = 30 hospitals) on antibiotic selection during the first 3 hospital days (empiric period) in noncritically ill adults (≥18 years) hospitalized with UTI with an 18-month baseline (April 1, 2017-September 30, 2018) and 15-month intervention period (April 1, 2019-June 30, 2020).InterventionsCPOE prompts recommending empiric standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics who have low estimated absolute risk (
- Published
- 2024