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Revolutionizing Infection Prevention: Leveraging EHRs to Reduce Antibiotic Overuse

Pneumonia and urinary tract infections (UTIs) are reportedly the most common conditions necessitating the hospitalization of American adults, with an alarmingly high number of these patients receiving unnecessary broad-spectrum antibiotics upon admission. It seems this over-prescription is driven by a fear of potential multidrug-resistant organisms (MDROs) possibly exacerbating the patients’ situation if not treated aggressively. However, if the subsequent culture results indicate the absence of an MDRO, physicians may de-escalate the therapy to standard-spectrum antibiotics. Unfortunately, even this brief contact with extended-spectrum antibiotics can pose significant risks, including predisposing the patient to future MDROs and the potentially life-threatening Clostridioides difficile infection.

The latest research led by Dr. Shruti Gohil, a renowned infectious disease specialist and associate medical director of epidemiology at the University of California Irvine School of Medicine, suggests a promising solution. Gohil’s research indicates that utilizing a computerized stewardship prompt within a hospital’s electronic health record (EHR) system could bolster physicians’ confidence in prescribing standard-spectrum antibiotics from the beginning, providing significant benefits in antibiotic stewardship and patient safety.

Gohil’s breakthrough study, known as the INSPIRE (Intelligent Stewardship Prompts to Improve Real-Time Empiric Antibiotic Selection) trials, involved adult patients hospitalized for pneumonia and UTIs across 59 hospitals within HCA Healthcare. The study demonstrated substantial reductions in extended-spectrum therapy in hospitals that incorporated computerized provider order entry (CPOE) prompts into their routine antibiotic stewardship activities. The CPOE utilized assessed a host of variables, determining the patient’s risk for an MDRO infection, guiding the physician’s choice of antibiotics, and thus enabling them to deliver extremely targeted treatment.

Gohil’s findings emphasize that the right information provided at the right time can significantly sway physician prescription habits, leading to better patient outcomes. Additionally, the INSPIRE trials were among the largest to focus on empiric prescribing practices, emphasising the importance of initiating a standard-spectrum antibiotic regimen.

In the light of these resounding successes, infectious disease experts worldwide, including renowned physicians Anurag Malani, MD, of Trinity Michigan Health, and Preeti Malani, MD, of the University Michigan, have commended Gohil’s work, and strongly advocate more institutions to implement such EHR-based interventions to improve empiric prescribing.

Gohil’s pioneering trials indeed inspire us to explore innovative solutions and reinforce the need for meticulous, data-driven research to positively influence prescribing habits and contribute to significant breakthroughs in infection prevention strategies.

Source: https://www.cidrap.umn.edu/antimicrobial-stewardship/computerized-stewardship-prompt-linked-improved-antibiotic-prescribing

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