Reviewed by Barry Rittmann, MD, MPH, Virginia Commonwealth University
The INSPIRE 4 study is the fourth in a line of RCTs that evaluate the use of bundled antibiotic stewardship interventions, centralized around computerized provider order entry (CPOE), with education to encourage improved empiric antibiotic selection. In this study, researchers focused on abdominal infection usage, assessing the need for MDRO coverage, including the usage of anti-pseudomonal agents and Vancomycin. In this 92-hospital cluster-randomized trial, researchers evaluated 198,480 patients and found a 35% relative risk reduction (P<0.001) in empiric extended-spectrum antibiotic days of therapy, with no evidence of inferiority in intensive care unit transfers or length of stay. This intervention is the latest in automated electronic approaches to guiding providers to more appropriate empiric antibiotics. This approach has also been used in skin and soft tissue infections, urinary tract infections, and pneumonia.
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