INSPIRE (INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection for Patients): The INSPIRE-ASP Trial for Intra-Abdominal and Skin and Soft Tissue Infections

INSPIRE（智能管理提示改善患者实时经验性抗生素选择）：针对腹内、皮肤和软组织感染的 INSPIRE-ASP 试验

• 批准号: 10198711
• 负责人: Susan S. Huang
• 金额: $ 157.4万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-19 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10198711
• 关键词: Abdomen; Abdominal Infection; Algorithms; Antibiotic Resistance; Antibiotic Therapy; Antibiotics; Bacterial Antibiotic Resistance; Characteristics; Clinical; Cluster randomized trial; Community Hospitals; Data; Disease; Electronic Health Record; Epidemiology; Feedback; Goals; Hospitals; Infection; Intelligence; Intensive Care Units; Intervention; Intra-abdominal; Knowledge; Length of Stay; Measures; Methods; Organism; Outcome; Patient Selection; Patient-Focused Outcomes; Patients; Physicians; Prevalence; Probability; Provider; Randomized; Resistance; Risk; Risk Estimate; Skin Tissue; Soft Tissue Infections; System; Time; antibiotic resistant infections; base; computerized; drug resistant pathogen; improved; pathogen; precision medicine; prediction algorithm; programs; randomized trial; routine care; soft tissue; trial comparing

Abstract The INSPIRE-ASP Trial (INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection for Patients) for Abdominal and Skin and Soft Tissue Infections The INSPIRE-ASP Trial (INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection for Patients) for Abdominal and Skin and Soft Tissue Infections is a cluster-randomized trial to improve judicious antibiotic prescribing for non-critically ill hospitalized patients with abdominal infections or skin and soft tissue infections. Currently, over half of non-critically ill patients with one of these infections receive extended-spectrum antibiotics when less than 5% have an antibiotic-resistant pathogen. The goal of this trial is to advise physicians to prescribe standard- vs extended spectrum empiric antibiotics based on an algorithm that estimates each patient’s personalized probability of having an antibiotic-resistant infection. This personalized probability is based upon routinely-collected patient information in the electronic health record and local prevalence of resistant organisms in abdominal or skin and soft tissue infections. This trial will compare routine care under hospital-based antibiotic stewardship programs to the enhanced program using the predictive algorithm plus audit and feedback to reduce unnecessary empiric prescribing of extended-spectrum antibiotics. In our first aim, we will develop disease-specific prediction algorithms for abdominal infections and for skin and soft tissue infections. In our second aim, this predictive algorithm will be integrated into the computerized provider order entry (CPOE) system to prompt physicians when selected antibiotics are discordant with the estimated need for that antibiotic. Physicians will be prompted to use standard-spectrum antibiotics when the risk of an antibiotic-resistant infection is low. Sixty hospitals will be randomized to either routine care or the CPOE prompt intervention plus feedback. This 18-month study will evaluate ~53,000 patients with abdominal infections and ~37,000 patients with skin and soft tissue infections. This trial will evaluate the ability of a real-time risk calculator plus audit and feedback to reduce unnecessary extended-spectrum antibiotics while maintaining good clinical outcomes as measured by length- of-stay and transfer to an intensive care unit. These methods will be readily applicable to other electronic health record prescribing systems.

抽象的 INSPIRE-ASP 试验（智能管理提示改善实时经验性抗生素 腹部、皮肤和软组织感染患者的选择 INSPIRE-ASP 试验（智能管理提示改善实时经验性抗生素 针对腹部、皮肤和软组织感染的患者选择是一项整群随机试验，旨在 改善对患有腹部感染的非危重住院患者或患者的明智抗生素处方 目前，超过一半的非重症患者患有其中一种感染。 当少于 5% 的病原体具有抗生素耐药性时，接受广谱抗生素治疗。 该试验的目的是建议医生根据以下情况开出标准广谱经验性抗生素与广谱经验性抗生素： 估计每个患者出现抗生素耐药性感染的个性化概率的算法。 个性化概率基于电子健康记录中定期收集的患者信息 腹部或皮肤和软组织感染中耐药微生物的局部流行。 该试验将比较医院抗生素管理计划下的常规护理与 使用预测算法加上审核和反馈来增强程序，以减少不必要的经验 开出广谱抗生素 在我们的第一个目标中，我们将开发针对疾病的预测。 我们的第二个目标是针对腹部感染以及皮肤和软组织感染的算法。 算法将被集成到计算机化医疗服务提供者订单输入（CPOE）系统中以提示医生 当选择的抗生素与该抗生素的估计需求不一致时，将提示医生。 当抗生素耐药性感染的风险较低时，六十家医院将使用标准谱抗生素。 这项为期 18 个月的研究将随机接受常规护理或 CPOE 及时干预和反馈。 评估约 53,000 名腹部感染患者和约 37,000 名皮肤和软组织感染患者。 该试验将评估实时风险计算器以及审计和反馈的能力，以减少风险 不必要的广谱抗生素，同时保持良好的临床结果（根据长度测量） 这些方法将很容易适用于其他电子设备。 健康记录处方系统。