INSPIRE-ASP PNA
Trial question
What is the role of computerized provider order entry prompts recommending standard-spectrum antibiotics for non-critically ill patients hospitalized with pneumonia?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
52.0% female
48.0% male
N = 44780
44780 patients (23269 female, 21511 male).
Inclusion criteria: non-critically ill patients hospitalized with pneumonia.
Key exclusion criteria: age < 18 years.
Interventions
N=22782 CPOE bundle (computerized provider order entry prompts recommending standard-spectrum antibiotics along with clinician education and feedback).
N=21998 routine stewardship (educational materials and quarterly coaching calls to maintain stewardship activities per national guidelines).
Primary outcome
Extended-spectrum days of therapy
428.5 days
615.2 days
615.2 days
461.4 days
307.6 days
153.8 days
0.0 days
CPOE
bundle
Routine
stewardship
Significant
decrease ▼
Significant decrease in extended-spectrum days of therapy (428.5 days vs. 615.2 days; RR 0.72, 95% CI 0.66 to 0.78).
Secondary outcomes
Significant decrease in vancomycin days of therapy (161.4 days vs. 219.1 days; RR 0.77, 95% CI 0.71 to 0.83).
Significant decrease in antipseudomonal days of therapy (240.1 days vs. 360.7 days; RR 0.68, 95% CI 0.61 to 0.75).
Safety outcomes
No significant differences in length of stay, time to ICU transfer.
Significant difference in time to antibiotic escalation (6.1 days vs. 5.3 days).
Conclusion
In non-critically ill patients hospitalized with pneumonia, CPOE bundle was superior to routine stewardship with respect to a extended-spectrum days of therapy.
Reference
Shruti K Gohil, Edward Septimus, Ken Kleinman et al. Stewardship Prompts to Improve Antibiotic Selection for Pneumonia: The INSPIRE Randomized Clinical Trial. JAMA. 2024 Jun 18;331(23):2007-2017.
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