Two Clinical Trials Identify a Better Way to Target Appropriate Antibiotics for Patients Hospitalized With Pneumonia or Urinary Tract Infection

Two large multi-state studies uncovered a highly effective way to improve antibiotic selection for patients hospitalized with pneumonia or urinary tract infections (UTI), enabling better antibiotic stewardship in hospitals, according to research studies published today in the Journal of the American Medical Association (JAMA).

Stewardship Prompts to Improve Antibiotic Selection for Pneumonia
Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection

The studies, led by Harvard Pilgrim Health Care Institute, HCA Healthcare and the University of California, Irvine, were funded by the Centers for Disease Control and Prevention (CDC).

Antibiotic resistance, which occurs when germs like bacteria and fungi mutate to defeat the drugs designed to kill them, is a major public health threat. 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. The two newly published studies, the INSPIRE Pneumonia and UTI Trials, involved more than 220,000 patients with pneumonia or UTI in 59 HCA Healthcare hospitals. In half of the hospitals, clinicians were given algorithm driven computerized alerts with information about the best antibiotic match for an individual patient at the moment antibiotics were being prescribed. This resulted in a better match for 28% of pneumonia patients and 17% of patients with UTI when compared to hospitals where physicians were not provided with alerts according to the trials.

The alerts used patient characteristics from the electronic medical record as well as hospital and location-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 200,000 HCA Healthcare patients with pneumonia and UTI. Physicians treating patients with a low risk for antibiotic-resistant bacteria were prompted to give standard-spectrum antibiotics.

“Pneumonia and urinary tract infections are two of the most common infections requiring hospitalization and a major reason for overuse of broad-spectrum antibiotics,” said Sujan Reddy, MD, Medical Officer in the Epidemiology, Research and Innovations Branch of CDC’s Division of Healthcare Quality Promotion. “The INSPIRE trials have found a highly effective way to help physicians follow treatment recommendations to optimize antibiotic selection for each patient. These trials show the value of harnessing electronic health data to improve best practice.”