Targeted alerts may help doctors choose the right antibiotics

Targeted alerts may help doctors choose the right antibiotic: © wladimir1804 - stock.adobe.com

A new approach using real-time electronic alerts has significantly improved antibiotic selection in hospitals, potentially reducing the risk of antibiotic resistance, according to two major studies published in JAMA Surgery and JAMA Internal Medicine.

The multi-state trials, known as the INSPIRE Abdominal and Skin & Soft Tissue Trials, were led by researchers at the University of California, Irvine, Harvard Pilgrim Health Care Institute, and HCA Healthcare, and funded by the National Institutes of Health. The results were also presented at the Congress of the European Society of Clinical Microbiology and Infectious Diseases.

Involving more than 316,000 patients across 92 HCA Healthcare hospitals, the studies tested whether providing clinicians with targeted alerts at the moment antibiotics were ordered would help improve prescribing. The alerts drew on each patient’s electronic health record and hospital-specific data to estimate the risk of antibiotic-resistant infection.

For patients at low risk, doctors were advised to consider switching from broad-spectrum antibiotics—which target a wide range of bacteria—to narrower-spectrum options better aligned with current guidelines. The result: a 35% improvement in appropriate antibiotic selection for abdominal infections and a 28% improvement for skin and soft tissue infections, compared with hospitals that didn’t use the alerts.

“The right information at the right time can improve physician antibiotic selection,” said Shruti Gohil, MD, associate professor in the Division of Infectious Diseases at the University of California, Irvine School of Medicine. “Many different bacteria can cause abdominal or skin/soft tissue infections, and picking the best matched antibiotic can be a challenge. Results from these trials show that giving physicians an alert informing them of their patient’s actual risk for antibiotic resistance can help them choose the best antibiotic and reduce extended-spectrum antibiotic use.”

Antibiotic resistance is a growing global health threat. According to the CDC, more than 2.8 million infections involving antibiotic-resistant bacteria occur in the U.S. each year. The World Health Organization attributed 1.27 million deaths to antibacterial resistance in 2019. Broad-spectrum antibiotics are often prescribed out of caution but can disrupt healthy bacteria and increase the risk of complications like C. difficile infection and organ toxicity.

This is the latest in a series of INSPIRE studies focused on improving antibiotic use for common hospital infections. Earlier trials targeting pneumonia and urinary tract infections yielded similar results and have already led to system-wide adoption of real-time alerts across HCA Healthcare’s network.

“HCA Healthcare is committed to using our scale and data ecosystem to answer important clinical questions that benefit patients,” said Kenneth Sands, MD, chief epidemiologist at HCA Healthcare. “The ability to identify patients at low-risk for antibiotic resistance to limit the overall use of wide-spectrum antibiotics can help hospitals improve antibiotic stewardship efforts and curb resistance.”

HCA Healthcare is now working to expand these antibiotic prescribing protocols across its 190 hospitals. The large size and diversity of the study population—which included community hospitals across 15 states—suggest the findings could be applied broadly to hospitals nationwide, according to researcher.