201. Stewardship Prompts to Improve Antibiotic Selection for Pneumonia
- Author
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Gohil, Shruti K, Septimus, Edward, Kleinman, Ken, Varma, Neha, Avery, Taliser R, Heim, Lauren, Rahm, Risa, Cooper, William S, Cooper, Mandelin, McLean, Laura E, Nickolay, Naoise G, Weinstein, Robert A, Burgess, L Hayley, Coady, Micaela H, Rosen, Edward, Sljivo, Selsebil, Sands, Kenneth E, Moody, Julia, Vigeant, Justin, Rashid, Syma, Gilbert, Rebecca F, Smith, Kim N, Carver, Brandon, Poland, Russell E, Hickok, Jason, Sturdevant, SG, Calderwood, Michael S, Weiland, Anastasiia, Kubiak, David W, Reddy, Sujan, Neuhauser, Melinda M, Srinivasan, Arjun, Jernigan, John A, Hayden, Mary K, Gowda, Abinav, Eibensteiner, Katyuska, Wolf, Robert, Perlin, Jonathan B, Platt, Richard, and Huang, Susan S
- Subjects
Medical Microbiology ,Biomedical and Clinical Sciences ,Clinical Sciences ,Pneumonia ,Pneumonia & Influenza ,Infectious Diseases ,Patient Safety ,Comparative Effectiveness Research ,Lung ,Clinical Research ,Infection ,Aged ,Female ,Humans ,Male ,Middle Aged ,Anti-Bacterial Agents ,Antimicrobial Stewardship ,Drug Resistance ,Multiple ,Bacterial ,Hospitalization ,Medical Order Entry Systems ,Pneumonia ,Bacterial ,United States ,Aged ,80 and over ,Medical and Health Sciences ,General & Internal Medicine ,Biomedical and clinical sciences ,Health sciences - Abstract
ImportancePneumonia is the most common infection requiring hospitalization and is a major reason for overuse of extended-spectrum antibiotics. Despite low risk of multidrug-resistant organism (MDRO) infection, clinical uncertainty often drives initial antibiotic selection. Strategies to limit empiric antibiotic overuse for patients with pneumonia are needed.ObjectiveTo evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO infection risk estimates could reduce empiric extended-spectrum antibiotics for non-critically ill patients admitted with pneumonia.Design, setting, and participantsCluster-randomized trial in 59 US community hospitals comparing the effect of a CPOE stewardship bundle (education, feedback, and real-time MDRO risk-based CPOE prompts; n = 29 hospitals) vs routine stewardship (n = 30 hospitals) on antibiotic selection during the first 3 hospital days (empiric period) in non-critically ill adults (≥18 years) hospitalized with pneumonia. There was an 18-month baseline period from April 1, 2017, to September 30, 2018, and a 15-month intervention period from April 1, 2019, to June 30, 2020.InterventionCPOE prompts recommending standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics during the empiric period who have low estimated absolute risk (
- Published
- 2024